MEDICARE: JOANNA E. KELLY CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP9330786	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760768881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA E. KELLY CRNA

Provider Business Mailing Address
First Line	:	95429 BARNWELL RD
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-1698
Country	:	US
Telephone Number	:	904-321-3533
Fax Number	:	517-787-7365

Provider Business Practice Location Address
First Line	:	95429 BARNWELL RD
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-1698
Country	:	US
Telephone Number	:	904-321-3533
Fax Number	:	517-787-7365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2011
Last Update Date	:	10/20/2014

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