Provider Demographics
NPI:1629686415
Name:PILLADO, JOHANNA B (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:B
Last Name:PILLADO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5401
Mailing Address - Country:US
Mailing Address - Phone:321-614-6463
Mailing Address - Fax:321-338-7291
Practice Address - Street 1:1800 BROOKSHIRE CIR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-6670
Practice Address - Country:US
Practice Address - Phone:321-614-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty