Provider Demographics
NPI:1124291083
Name:SPINNATO, JOANN T (PNP)
Entity type:Individual
Prefix:MS
First Name:JOANN
Middle Name:T
Last Name:SPINNATO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GILLETTE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2514
Mailing Address - Country:US
Mailing Address - Phone:631-790-3413
Mailing Address - Fax:631-438-0303
Practice Address - Street 1:101 GILLETTE AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2514
Practice Address - Country:US
Practice Address - Phone:631-790-3413
Practice Address - Fax:631-438-0303
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY456583-1363AM0700X
NY381840363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03280059Medicaid