Provider Demographics
NPI:1396961587
Name:JOHNSON, YOLANDA GAIL
Entity type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:GAIL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 W WOOLBRIGHT RD STE 403
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6367
Mailing Address - Country:US
Mailing Address - Phone:561-914-4098
Mailing Address - Fax:
Practice Address - Street 1:400 VIA LUGANO CIR APT 109
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7165
Practice Address - Country:US
Practice Address - Phone:561-914-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9372891364SH0200X
FLPN5157974164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health