Provider Demographics
NPI:1255453205
Name:DELONGAIG, JOHANNA P (CNM)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:P
Last Name:DELONGAIG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ARLINGTON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3507
Mailing Address - Country:US
Mailing Address - Phone:941-379-6331
Mailing Address - Fax:941-379-5642
Practice Address - Street 1:1950 ARLINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3507
Practice Address - Country:US
Practice Address - Phone:941-379-6331
Practice Address - Fax:941-379-5642
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9430582367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP15035Medicare UPIN
NJ041604Medicare ID - Type Unspecified
NJ5638909Medicaid