Healthcare Provider Details

I. General information

NPI: 1154954287
Provider Name (Legal Business Name): PATRICK JOUISSANCE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 NW 40TH AVE STE 200
LAUDERHILL FL
33313-5801
US

IV. Provider business mailing address

5010 HOLLYWOOD BLVD # 5012,
HOLLYWOOD FL
33021-1330
US

V. Phone/Fax

Practice location:
  • Phone: 954-583-4710
  • Fax: 954-583-4711
Mailing address:
  • Phone: 954-266-2999
  • Fax: 954-966-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: