Provider Demographics
NPI:1831479856
Name:JOHNSON, LAVERN JOY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAVERN
Middle Name:JOY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-2428
Mailing Address - Country:US
Mailing Address - Phone:954-646-0709
Mailing Address - Fax:
Practice Address - Street 1:9210 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2428
Practice Address - Country:US
Practice Address - Phone:954-646-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2685182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner