Healthcare Provider Details

I. General information

NPI: 1861307894
Provider Name (Legal Business Name): LINDON JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20751 SW 80TH CT
CUTLER BAY FL
33189-3523
US

IV. Provider business mailing address

20751 SW 80TH CT
CUTLER BAY FL
33189-3523
US

V. Phone/Fax

Practice location:
  • Phone: 305-798-9186
  • Fax:
Mailing address:
  • Phone:
  • Fax: 305-798-9186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11049594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: