Healthcare Provider Details

I. General information

NPI: 1073669909
Provider Name (Legal Business Name): JOAN SPINNER HAYNES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 PONDELLA RD
N FT MYERS FL
33903-3532
US

IV. Provider business mailing address

3912 ROSEMARY DR
PUNTA GORDA FL
33950-1717
US

V. Phone/Fax

Practice location:
  • Phone: 239-656-3461
  • Fax: 239-656-3462
Mailing address:
  • Phone: 941-567-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberME0082263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: