Provider Demographics
NPI:1033172838
Name:JOHNS, LEONARD PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:PAUL
Last Name:JOHNS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:ELFERS
Mailing Address - State:FL
Mailing Address - Zip Code:34680-0262
Mailing Address - Country:US
Mailing Address - Phone:813-310-5679
Mailing Address - Fax:727-264-6235
Practice Address - Street 1:4122 MADISON ST UNIT 262
Practice Address - Street 2:
Practice Address - City:ELFERS
Practice Address - State:FL
Practice Address - Zip Code:34680-9711
Practice Address - Country:US
Practice Address - Phone:813-310-5679
Practice Address - Fax:727-264-6235
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102691363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291797100Medicaid
FLP00150341OtherRAILROAD MEDICARE
FL291797100Medicaid
Q11930Medicare UPIN
FLU2156ZMedicare PIN
FLU2156YMedicare PIN