Diantha Lucretia Johnson, Nurse Practitioner
Nurse Practitioner, Family in Miramar, FL. Individual provider (NPI-1).
NPI number1942017561
StatusActive
Last updated in NPPESDec 17, 2024
Details
- NPI
- 1942017561
- Entity type
- Individual (NPI-1)
- Name
- Diantha Lucretia Johnson
- Credential
- Nurse Practitioner
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Dec 17, 2024
- Certification date
- Dec 17, 2024
- Last updated
- Dec 17, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 11036737 | FL | Yes |
Practice location
8140 Sw 29th StMiramar, FL 33025-6712
Phone 954-854-5220
Mailing address
8140 Sw 29th StMiramar, FL 33025-6712
Phone 954-854-5220
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