Provider Demographics
NPI:1518661388
Name:JOHNSON, ZACHORY TODD (NP)
Entity Type:Individual
Prefix:
First Name:ZACHORY
Middle Name:TODD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N FLAGLER DR STE 350
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-4349
Mailing Address - Country:US
Mailing Address - Phone:561-725-9541
Mailing Address - Fax:
Practice Address - Street 1:515 N FLAGLER DR STE 350
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-4349
Practice Address - Country:US
Practice Address - Phone:561-725-9541
Practice Address - Fax:561-823-3568
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025660363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health