Provider Demographics
NPI:1871543520
Name:VERKADEN, JANELL L (ARNP)
Entity type:Individual
Prefix:
First Name:JANELL
Middle Name:L
Last Name:VERKADEN
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:325 CLYDE MORRIS BLVD STE 450
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8179
Practice Address - Country:US
Practice Address - Phone:386-673-2442
Practice Address - Fax:386-673-4884
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 14I79242363L00000X
FLAPRN1479242363LA2200X
FL364SX0200X364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110958500Medicaid
FLARNP 1479242OtherLICENSE
FLARNP 1479242OtherLICENSE