Healthcare Provider Details

I. General information

NPI: 1144303009
Provider Name (Legal Business Name): JOHN PAUL MINNI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S KANNER HWY
STUART FL
34994-4622
US

IV. Provider business mailing address

1400 SE GOLDTREE DRIVE SUITE A-7
PORT ST. LUCIE FL
34952
US

V. Phone/Fax

Practice location:
  • Phone: 772-219-2777
  • Fax: 772-219-0017
Mailing address:
  • Phone: 772-335-3550
  • Fax: 772-237-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8747
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS8747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: