Healthcare Provider Details

I. General information

NPI: 1467714980
Provider Name (Legal Business Name): ANNA C. JUNCADELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 CREEKSIDE BLVD E UNIT 102
NAPLES FL
34109-0595
US

IV. Provider business mailing address

1285 CREEKSIDE BLVD E UNIT 102
NAPLES FL
34109-0595
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-8070
  • Fax: 239-624-8071
Mailing address:
  • Phone: 239-624-8070
  • Fax: 239-624-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL-251777
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME136594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: