Provider Demographics
NPI:1992709224
Name:MOOGANZUCKERMAN, JOAN L (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:L
Last Name:MOOGANZUCKERMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:LEE
Other - Last Name:MOOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4523 MERGANSER CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-7970
Mailing Address - Country:US
Mailing Address - Phone:267-566-1843
Mailing Address - Fax:
Practice Address - Street 1:4523 MERGANSER CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-7970
Practice Address - Country:US
Practice Address - Phone:267-566-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN203802L367500000X
FLAPRN9238080367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZU073830Medicare UPIN
PAZU073830Medicare ID - Type Unspecified