Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS14158 | FL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | OS14158 | FL |
NPI | 1154602324 |
---|---|
Provider Name | Dr. John Anthony Pennisi |
First Address | Naples, FL 34109-0493 |
Second Address | Naples, FL 34109-0493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2011 |
Last Update Date | 18/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018289700 | (05) | FL |
MEDICARE | IQ861Z (01) | FL |
NT1FU | BCBS (01) | FL |