Healthcare Provider Details

I. General information

NPI: 1720698376
Provider Name (Legal Business Name): JANISA RENEE NOEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 NW 23RD AVE
CHIEFLAND FL
32626-1911
US

IV. Provider business mailing address

487 NE 250TH AVE
OLD TOWN FL
32680-3033
US

V. Phone/Fax

Practice location:
  • Phone: 352-493-9500
  • Fax: 352-490-9450
Mailing address:
  • Phone: 352-646-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9551802
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: