Provider Demographics
NPI:1316902034
Name:JENSEN, JOANNA (ARNP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:JENSEN
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 1:1555 US HIGHWAY 1 STE 105
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4728
Mailing Address - Country:US
Mailing Address - Phone:772-257-8224
Mailing Address - Fax:772-571-1602
Practice Address - Street 1:1555 US HIGHWAY 1 STE 105
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4728
Practice Address - Country:US
Practice Address - Phone:772-257-8224
Practice Address - Fax:772-571-1602
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1568722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP1568722OtherLICENSE- ARNP - FAMILY
FL306408500Medicaid
FLU2835AMedicare PIN