Provider Demographics
NPI:1447680335
Name:AHMADIAN, JOANNA (ARNP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:AHMADIAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:611 FATHOM CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5796
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2894 W BAY DR
Practice Address - Street 2:
Practice Address - City:BELLEAIR BLUFFS
Practice Address - State:FL
Practice Address - Zip Code:33770-2620
Practice Address - Country:US
Practice Address - Phone:727-518-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9298147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily