Provider Demographics
NPI:1700358199
Name:FELL, JOAN W
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:W
Last Name:FELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25181 HARBORSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33955-4227
Mailing Address - Country:US
Mailing Address - Phone:941-457-0892
Mailing Address - Fax:941-347-7000
Practice Address - Street 1:25181 HARBORSIDE BLVD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33955-4227
Practice Address - Country:US
Practice Address - Phone:941-457-0892
Practice Address - Fax:941-347-7000
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-22
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant