Healthcare Provider Details

I. General information

NPI: 1386399095
Provider Name (Legal Business Name): JOHARI PATRICE FAISON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N 12TH AVE
ARCADIA FL
34266-8752
US

IV. Provider business mailing address

700 8TH AVE W STE 101
PALMETTO FL
34221-4737
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-1242
  • Fax: 863-491-0466
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-845-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11016744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: