MEDICARE: JOAN WEBER IACOBELLI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	16001	AL
2	208600000X	Surgery Physician	ME 108529	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	051083966	OTHER	AL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	14C4Y	OTHER	FL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144267121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN WEBER IACOBELLI M.D.

Provider Business Mailing Address
First Line	:	2864 WELLNESS AVE STE 200
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8335
Country	:	US
Telephone Number	:	386-775-0333
Fax Number	:	386-775-0427

Provider Business Practice Location Address
First Line	:	2864 WELLNESS AVE STE 200
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8335
Country	:	US
Telephone Number	:	386-775-0333
Fax Number	:	386-775-0427

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	01/31/2020

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Directions to “ JOAN WEBER IACOBELLI M.D.” Practice Location

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