Provider Demographics
NPI:1457739468
Name:REEVES, JOANNA SERIENO (FNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:SERIENO
Last Name:REEVES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:ROSE
Other - Last Name:SERIENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:SUITE B460
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-454-2226
Practice Address - Fax:864-454-2223
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily