Healthcare Provider Details

I. General information

NPI: 1700159340
Provider Name (Legal Business Name): JEANNETTE G WARNER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 05/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 MALABAR RD SE STE 1
PALM BAY FL
32907-3407
US

IV. Provider business mailing address

1270 MALABAR RD SE STE 1
PALM BAY FL
32907-3407
US

V. Phone/Fax

Practice location:
  • Phone: 321-722-1944
  • Fax:
Mailing address:
  • Phone: 321-722-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME0063433
License Number StateFL

VIII. Authorized Official

Name: DR. JEANNETTE G WARNER
Title or Position: PRESIDENT
Credential: MD
Phone: 321-722-1944