Provider Demographics
NPI:1437201605
Name:RHYMES-JOHNSON, PHYLLIS WANDA (ARNP,MSN,DHS-STUDENT)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:WANDA
Last Name:RHYMES-JOHNSON
Suffix:
Gender:F
Credentials:ARNP,MSN,DHS-STUDENT
Other - Prefix:MS
Other - First Name:PHYLLIS
Other - Middle Name:WANDA
Other - Last Name:RHYMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP,MSN,DHS-STUDENT
Mailing Address - Street 1:870 N.W. 177TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169
Mailing Address - Country:US
Mailing Address - Phone:305-793-9612
Mailing Address - Fax:305-653-9882
Practice Address - Street 1:JACKSON HEALTH SYSTEM - 1611 N.W. 12TH AVENUE
Practice Address - Street 2:DEVICE CENTER - WW 407
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169
Practice Address - Country:US
Practice Address - Phone:305-585-7443
Practice Address - Fax:305-585-6872
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1060592363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20006OtherJACKSON HEALTH SYSTEM ID