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General NPI Number Information
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NPI Number | 1346996378
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Entity Type | Individual
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Provider Name | JOHNSON MONESTIME
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Gender | Male
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 7456 VISCAYA CIR
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City | MARGATE
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State | FL
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Zip | 33063-6892
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Country | US
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Telephone | 772-985-6651
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Fax |
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Provider Business Mailing Address
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Address Line | 7456 VISCAYA CIR
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City | MARGATE
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State | FL
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Zip | 33063-6892
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Country | US
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Telephone | 772-985-6651
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1132-PA
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | MO
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