=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720698376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANISA RENEE NOEL APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2020
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1113 NW 23RD AVE
-----------------------------------------------------
City | CHIEFLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32626-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-493-9500
-----------------------------------------------------
Fax | 352-490-9450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 609 SE BRANDON DR
-----------------------------------------------------
City | LAKE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32025-7297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-716-3995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WE0003X
-----------------------------------------------------
Taxonomy Name | Emergency Registered Nurse
-----------------------------------------------------
License Number | RN9551802
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11033499
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------