Provider Demographics
NPI:1598501983
Name:MYERS, JOANNA ERICKA ANTONIO (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JOANNA ERICKA
Middle Name:ANTONIO
Last Name:MYERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:JOANNA ERICKA
Other - Middle Name:VILLANUEVA
Other - Last Name:ANTONIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:218 GREGORY DR
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-0001
Practice Address - Country:US
Practice Address - Phone:574-271-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029955363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine