MEDICARE: MS. ROBYN ANN POLINER-JOHNSON PA-C

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	363A00000X	Physician Assistant	PA9103590	FL

General Provider Information

NPI Number	:	1962541433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBYN ANN POLINER-JOHNSON PA-C

Provider Business Mailing Address
First Line	:	219 S K ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4130
Country	:	US
Telephone Number	:	714-393-4409
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 OCEAN DR
Second Line	:	SUITE 11
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-5131
Country	:	US
Telephone Number	:	561-364-8056
Fax Number	:	561-364-8507

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	10/20/2016

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