Provider Demographics
NPI:1811917859
Name:ANDERSON, JOETTE EILEEN (ARNP)
Entity type:Individual
Prefix:
First Name:JOETTE
Middle Name:EILEEN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOETTE
Other - Middle Name:E
Other - Last Name:STROMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 16568
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-6568
Mailing Address - Country:US
Mailing Address - Phone:904-472-2300
Mailing Address - Fax:904-472-2330
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:SUITE 1202
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8339
Practice Address - Country:US
Practice Address - Phone:904-399-4862
Practice Address - Fax:904-346-5410
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 865542363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308339000Medicaid
FLAG569YMedicare PIN