Healthcare Provider Details

I. General information

NPI: 1720900632
Provider Name (Legal Business Name): PATRICIA ROSEMARIE JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 N NOB HILL RD
SUNRISE FL
33351-4799
US

IV. Provider business mailing address

8541 NW 53RD CT
LAUDERHILL FL
33351-4818
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-3600
  • Fax:
Mailing address:
  • Phone: 954-579-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: