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General NPI Number Information
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NPI Number | 1194883199
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Entity Type | Individual
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Provider Name | DOREEN LYNN JOHNSON PA-C, MPH
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 601 N CONGRESS AVE SUITE 113-A
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-3444
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Country | US
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Telephone | 561-381-9979
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Fax | 561-381-9989
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Provider Business Mailing Address
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Address Line | 263 LAKE MONTEREY CIR
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8443
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Country | US
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Telephone | 954-608-6352
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9102545
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License Number State | FL
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