Provider Demographics
NPI:1699354159
Name:DUARTE, JOHANNA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ELIZABETH
Last Name:DUARTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24646 SW 108TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4671
Mailing Address - Country:US
Mailing Address - Phone:786-237-8117
Mailing Address - Fax:
Practice Address - Street 1:24646 SW 108TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4671
Practice Address - Country:US
Practice Address - Phone:786-237-8117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114078363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical