Healthcare Provider Details

I. General information

NPI: 1912707209
Provider Name (Legal Business Name): JOANNA MAE LEVY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2025
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CORAL HILLS DR
STUART FL
34996
US

IV. Provider business mailing address

104 N LAKESHORE DR
HYPOLUXO FL
33462-6069
US

V. Phone/Fax

Practice location:
  • Phone: 772-284-7000
  • Fax:
Mailing address:
  • Phone: 561-954-2445
  • Fax: 561-954-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11038222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: