Healthcare Provider Details

I. General information

NPI: 1346242708
Provider Name (Legal Business Name): JOANNE P MIDDLETON CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BEACH 129 ST
ROCKAWAY PARK NY
11694
US

IV. Provider business mailing address

119 BEACH 129 ST
ROCKAWAY PARK NY
11694
US

V. Phone/Fax

Practice location:
  • Phone: 718-486-7374
  • Fax: 718-486-6927
Mailing address:
  • Phone: 718-486-7374
  • Fax: 718-486-6927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF000385
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF360200-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: