MEDICARE: MS. YOLANDA GAIL JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SH0200X	Home Health Clinical Nurse Specialist	RN9372891	FL
2	164W00000X	Licensed Practical Nurse	PN5157974	FL

General Provider Information

NPI Number	:	1396961587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YOLANDA GAIL JOHNSON

Provider Business Mailing Address
First Line	:	2240 W WOOLBRIGHT RD STE 403
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-6367
Country	:	US
Telephone Number	:	561-914-4098
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 VIA LUGANO CIR APT 109
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-7165
Country	:	US
Telephone Number	:	561-914-4098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	06/27/2021

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