Provider Demographics
NPI:1003392481
Name:PEDRAZA, JOHANNA (ARNP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:PEDRAZA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N ALEXANDER ST STE B
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4302
Mailing Address - Country:US
Mailing Address - Phone:813-719-3525
Mailing Address - Fax:813-719-3175
Practice Address - Street 1:210 N ALEXANDER ST STE B
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4302
Practice Address - Country:US
Practice Address - Phone:813-719-3525
Practice Address - Fax:813-719-3175
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9311872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily