Healthcare Provider Details

I. General information

NPI: 1740264175
Provider Name (Legal Business Name): LATOYA MONIQUE JOHNSON PA-C, DHSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATOYA MONIQUE HAYNES PA-C

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10115 FOREST HILL BLVD STE 401
WELLINGTON FL
33414-3103
US

IV. Provider business mailing address

PO BOX 947387
ATLANTA GA
30394-7387
US

V. Phone/Fax

Practice location:
  • Phone: 561-472-5810
  • Fax:
Mailing address:
  • Phone: 561-472-5810
  • Fax: 561-472-5811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117648
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3562
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9117648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: