Provider Demographics
NPI:1720451446
Name:JOAN M MCNEELA
Entity Type:Organization
Organization Name:JOAN M MCNEELA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCNEELA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:321-267-5577
Mailing Address - Street 1:1717 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-5002
Mailing Address - Country:US
Mailing Address - Phone:321-267-5577
Mailing Address - Fax:321-264-0724
Practice Address - Street 1:1717 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-5002
Practice Address - Country:US
Practice Address - Phone:321-267-5577
Practice Address - Fax:321-264-0724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1457213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720451446OtherGROUP NPI
FL4EDHKOtherFLORIDA BLUE INDENTIFICATION NUMBER FOR GROUP
FL4EDHKOtherFLORIDA BLUE INDENTIFICATION NUMBER FOR GROUP