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General NPI Number Information
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NPI Number | 1790550572
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Entity Type | Individual
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Provider Name | PATRICE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 11/21/2023
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 2499 GLADES RD STE 104
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City | BOCA RATON
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State | FL
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Zip | 33431-7260
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Country | US
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Telephone | 813-424-1401
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Fax |
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Provider Business Mailing Address
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Address Line | 4610 SW DACTYL ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-6683
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Country | US
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Telephone | 973-816-0674
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 1004910
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License Number State | FL
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