Provider Demographics
NPI:1194883199
Name:JOHNSON, DOREEN LYNN (PA-C, MPH)
Entity type:Individual
Prefix:MISS
First Name:DOREEN
Middle Name:LYNN
Last Name:JOHNSON
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Gender:F
Credentials:PA-C, MPH
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Mailing Address - Street 1:263 LAKE MONTEREY CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8443
Mailing Address - Country:US
Mailing Address - Phone:954-608-6352
Mailing Address - Fax:
Practice Address - Street 1:601 N CONGRESS AVE
Practice Address - Street 2:SUITE 113-A
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3444
Practice Address - Country:US
Practice Address - Phone:561-381-9979
Practice Address - Fax:561-381-9989
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-05-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102545363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ75971Medicare UPIN