Provider Demographics
NPI:1962564419
Name:STJEAN, JOAN (APRN)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:STJEAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-0535
Mailing Address - Country:US
Mailing Address - Phone:603-738-2445
Mailing Address - Fax:
Practice Address - Street 1:13850 NW 50TH AVE
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-8683
Practice Address - Country:US
Practice Address - Phone:603-738-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH026459-23-08363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3081656Medicaid
NHNP410601Medicare PIN