Provider Demographics
NPI:1740266840
Name:NOLAN, JOAN RENNE (ARNP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:RENNE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10548
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-0548
Mailing Address - Country:US
Mailing Address - Phone:727-824-8105
Mailing Address - Fax:727-867-6795
Practice Address - Street 1:1020 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3423
Practice Address - Country:US
Practice Address - Phone:727-461-1439
Practice Address - Fax:727-443-7230
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1006222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily