Provider Demographics
NPI:1548496375
Name:JOHNSON, GINA PLACIDA (RN,IBCLC)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:PLACIDA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MONTEREY WAY
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7801
Mailing Address - Country:US
Mailing Address - Phone:561-385-1301
Mailing Address - Fax:
Practice Address - Street 1:150 MONTEREY WAY
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7801
Practice Address - Country:US
Practice Address - Phone:561-385-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1467942163WL0100X
FL197-14029163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant