Provider Demographics
NPI:1154954287
Name:JOUISSANCE, PATRICK (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:JOUISSANCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 HOLLYWOOD BLVD # 5012,
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1330
Mailing Address - Country:US
Mailing Address - Phone:954-266-2999
Mailing Address - Fax:954-966-3320
Practice Address - Street 1:1295 NW 40TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5801
Practice Address - Country:US
Practice Address - Phone:954-583-4710
Practice Address - Fax:954-583-4711
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112785363A00000X
FL9112785207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine