Provider Demographics
NPI: | 1932214277 |
---|---|
Name: | JOYNER, HILARY A (PA -C) |
Entity Type: | Individual |
Prefix: | |
First Name: | HILARY |
Middle Name: | A |
Last Name: | JOYNER |
Suffix: | |
Gender: | F |
Credentials: | PA -C |
Other - Prefix: | |
Other - First Name: | HILARY |
Other - Middle Name: | A |
Other - Last Name: | RODRIGUEZ |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | PA-C |
Mailing Address - Street 1: | 3334 CAPITAL MEDICAL BLVD STE 400 |
Mailing Address - Street 2: | |
Mailing Address - City: | TALLAHASSEE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32308-4470 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 850-877-8174 |
Mailing Address - Fax: | 850-877-5636 |
Practice Address - Street 1: | 3334 CAPITAL MEDICAL BLVD STE 400 |
Practice Address - Street 2: | |
Practice Address - City: | TALLAHASSEE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32308-4470 |
Practice Address - Country: | US |
Practice Address - Phone: | 850-877-8174 |
Practice Address - Fax: | 850-877-5636 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-19 |
Last Update Date: | 2017-06-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PA9102095 | 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 018573800 | Medicaid | |
P00201244 | Medicare PIN | ||
Q36632 | Medicare UPIN | ||
FL | 018573800 | Medicaid |