Provider Demographics
NPI:1255757696
Name:FALLON, JOEL ROBERT
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ROBERT
Last Name:FALLON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HARBOR CENTER DR
Mailing Address - Street 2:SUITE 16
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8268
Mailing Address - Country:US
Mailing Address - Phone:386-447-6551
Mailing Address - Fax:386-447-6585
Practice Address - Street 1:9 HARBOR CENTER DR
Practice Address - Street 2:SUITE 16
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8268
Practice Address - Country:US
Practice Address - Phone:386-447-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211046374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide