Provider Demographics
NPI:1588062145
Name:PLUMETTAZ, JOANNA JANE (PA)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:JANE
Last Name:PLUMETTAZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:JANE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 TRANCAS ST STE 256
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2921
Practice Address - Country:US
Practice Address - Phone:707-251-3604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09577363AM0700X, 363A00000X
CAPA62986363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical