Provider Demographics
NPI:1306138037
Name:HAVENOR, JOAN L (CNM)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:L
Last Name:HAVENOR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10970
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-0970
Mailing Address - Country:US
Mailing Address - Phone:727-927-7656
Mailing Address - Fax:727-322-2150
Practice Address - Street 1:4000 GATEWAY CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-6138
Practice Address - Country:US
Practice Address - Phone:727-544-3900
Practice Address - Fax:727-530-7423
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP530922367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife