Provider Demographics
NPI:1467589267
Name:JOHNSON, THELMA ELAINE (RN,RNFA)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN,RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:849 UNIVERSITY BLVD
Mailing Address - Street 2:#205
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3079
Mailing Address - Country:US
Mailing Address - Phone:561-630-4467
Mailing Address - Fax:561-630-4467
Practice Address - Street 1:2201 45TH ST
Practice Address - Street 2:COLUMBIA HOSPITAL
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2047
Practice Address - Country:US
Practice Address - Phone:561-863-3855
Practice Address - Fax:561-881-5474
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN1475272363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6109OtherBLUE CROSS BLUESHIELD