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General NPI Number Information
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NPI Number | 1063375012
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Entity Type | Individual
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Provider Name | JOSEPHINE JOHN
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Gender | Female
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Dates
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Enumeration Date | 12/06/2025
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 1016 BENT CREEK DR
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City | FORT PIERCE
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State | FL
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Zip | 34947-1333
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Country | US
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Telephone | 954-263-3143
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 BENT CREEK DR
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City | FORT PIERCE
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State | FL
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Zip | 34947-1333
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN9529455
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License Number State | FL
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