Provider Demographics
NPI:1790580785
Name:DELPHIN, JOHANNA (FNP)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:DELPHIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 NW TOBLIN LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-3065
Mailing Address - Country:US
Mailing Address - Phone:305-834-3500
Mailing Address - Fax:
Practice Address - Street 1:1362 SW BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2929
Practice Address - Country:US
Practice Address - Phone:772-873-5213
Practice Address - Fax:772-873-5215
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11037367363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care