Provider Demographics
NPI:1861697906
Name:JOHNSON, SHARON DELORIS ELEASE (PA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DELORIS ELEASE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6101
Mailing Address - Country:US
Mailing Address - Phone:561-795-3330
Mailing Address - Fax:561-795-1030
Practice Address - Street 1:12953 PALMS WEST DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4990
Practice Address - Country:US
Practice Address - Phone:561-791-7969
Practice Address - Fax:561-791-7968
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103898363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPAX000748OtherPRESCRIPTION LICENSE #