Provider Demographics
NPI:1447031547
Name:GARNIQUE, JANELLE ALYSSA (APRN)
Entity type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:ALYSSA
Last Name:GARNIQUE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:ALYSSA
Other - Last Name:CARSTENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3730 PREAKNESS PL APT 1709
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4367
Mailing Address - Country:US
Mailing Address - Phone:239-209-2022
Mailing Address - Fax:
Practice Address - Street 1:303 W PALM AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-2027
Practice Address - Country:US
Practice Address - Phone:813-925-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120316100Medicaid