Provider Demographics
NPI:1396210555
Name:JOHNSON HYATT, SHARON PAULETTE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:PAULETTE
Last Name:JOHNSON HYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:PAULETTE
Other - Last Name:JOHNSON HYATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:4225 SW 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2777
Mailing Address - Country:US
Mailing Address - Phone:954-801-6346
Mailing Address - Fax:
Practice Address - Street 1:4225 SW 185TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-2777
Practice Address - Country:US
Practice Address - Phone:954-801-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2686112363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty