Provider Demographics
NPI:1316098940
Name:JOHNSON, MEL PAUL (PSYDR, RN, ARNP)
Entity type:Individual
Prefix:DR
First Name:MEL
Middle Name:PAUL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PSYDR, RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S ROYAL POINCIANA BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6134
Mailing Address - Country:US
Mailing Address - Phone:305-979-7425
Mailing Address - Fax:
Practice Address - Street 1:822 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3704
Practice Address - Country:US
Practice Address - Phone:305-856-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL858211163WC1600X
FL858212363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health