Provider Demographics
NPI:1477646214
Name:JOHNSON, SUZANNE P (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8175 NW 12TH ST
Mailing Address - Street 2:SUITE 306, ATTN.J.BASSI
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1828
Mailing Address - Country:US
Mailing Address - Phone:786-845-0164
Mailing Address - Fax:786-845-0176
Practice Address - Street 1:8175 NW 12TH ST
Practice Address - Street 2:SUITE 306, ATTN.J.BASSI
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1828
Practice Address - Country:US
Practice Address - Phone:786-845-0164
Practice Address - Fax:786-845-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN788692163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3022593400Medicaid