Healthcare Provider Details

I. General information

NPI: 1780874180
Provider Name (Legal Business Name): JOANNA LYNN WALKER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 SAN JOSE PARK DR
JACKSONVILLE FL
32217-4612
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-3530
  • Fax:
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-376-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: