Healthcare Provider Details

I. General information

NPI: 1346243649
Provider Name (Legal Business Name): JOHANNA PAOLA BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOHANNA PAOLA REINA

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13340 METRO PKWY STE 310
FORT MYERS FL
33966-4818
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1448
  • Fax: 239-343-4178
Mailing address:
  • Phone: 239-424-1500
  • Fax: 239-424-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101239801
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA80763
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME148976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: