Provider Demographics
NPI:1477970713
Name:OTONG, JOHNSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNSON
Middle Name:
Last Name:OTONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11255 SW 211TH ST
Mailing Address - Street 2:AMERICAN CARE, INC.
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2240
Mailing Address - Country:US
Mailing Address - Phone:305-278-0200
Mailing Address - Fax:786-235-0145
Practice Address - Street 1:2791 LAKE ALFRED RD
Practice Address - Street 2:AMERICAN CARE OF TAMPA, INC.
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-1432
Practice Address - Country:US
Practice Address - Phone:863-291-4590
Practice Address - Fax:863-508-6503
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP-9340098363LF0000X
WA60650287363LP2300X
PR16570I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP-9340098OtherARNP LICENSE