MEDICARE: GESSY TARGETE-JOHNSON CNM

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	ARNP2580612	FL
2	367A00000X	Advanced Practice Midwife	ARNP2580612	FL

General Provider Information

NPI Number	:	1982693610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GESSY TARGETE-JOHNSON CNM

Provider Business Mailing Address
First Line	:	20391 SW 1ST ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-5025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 NW 7TH AVE
Second Line	:	PHOENIX OBSTETRICS/GYNECOLOGY, LLC
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33311-9026
Country	:	US
Telephone Number	:	954-759-6789
Fax Number	:

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

Provider Enumeration Date	:	10/15/2005
Last Update Date	:	09/11/2025

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