Provider Demographics
NPI:1508496597
Name:BELIZAIRE, JOHANNA SAMMY JOSEPH
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:SAMMY JOSEPH
Last Name:BELIZAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-4998
Mailing Address - Country:US
Mailing Address - Phone:561-992-4357
Mailing Address - Fax:
Practice Address - Street 1:1301 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-4998
Practice Address - Country:US
Practice Address - Phone:561-992-4357
Practice Address - Fax:561-952-1805
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily