Provider Demographics
NPI:1346243649
Name:BROWN, JOHANNA PAOLA (MD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:PAOLA
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:PAOLA
Other - Last Name:REINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1500
Mailing Address - Fax:239-424-1423
Practice Address - Street 1:13340 METRO PKWY STE 310
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4818
Practice Address - Country:US
Practice Address - Phone:239-343-1448
Practice Address - Fax:239-343-4178
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239801207RI0200X
CAA80763207RI0200X
FLME148976207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010275458Medicaid
197750OtherANTHEM
FL111559400Medicaid
CAH86155Medicare UPIN
VAVV5336A933Medicare PIN
CA00A807630Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER