Provider Demographics
NPI:1982030276
Name:JOHNSON, CORLINA M (APRN-BC, AAHIVS)
Entity Type:Individual
Prefix:
First Name:CORLINA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN-BC, AAHIVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 COUNTRY LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6212
Mailing Address - Country:US
Mailing Address - Phone:704-726-8070
Mailing Address - Fax:786-567-5950
Practice Address - Street 1:44 COUNTRY LAKE CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6212
Practice Address - Country:US
Practice Address - Phone:786-567-5400
Practice Address - Fax:786-567-5950
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9274792363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology