Provider Demographics
NPI:1255450250
Name:SWAIN, JOAN EVE (PA)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:EVE
Last Name:SWAIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:EVE
Other - Last Name:MALCOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:807 S ORLANDO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4870
Mailing Address - Country:US
Mailing Address - Phone:407-894-4693
Mailing Address - Fax:407-261-3869
Practice Address - Street 1:807 S ORLANDO AVE STE C
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4870
Practice Address - Country:US
Practice Address - Phone:407-894-4693
Practice Address - Fax:407-261-3869
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9110284363A00000X
MI5601003492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601003492OtherPHYSICIANS ASSISTANT