Basic Information
| Provider Information | |||||||||
| NPI: | 1669487393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRESSMAN | ||||||||
| FirstName: | JOANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 2ND AVE S | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337014001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278963134 | ||||||||
| FaxNumber: | 7278275155 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 7TH AVENUE NORTH | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | ST. PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337051300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278251100 | ||||||||
| FaxNumber: | 7278275155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 06/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ME66504 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 25876 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 376034100 | 05 | FL | MEDICAID |