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2054 Vista Pkwy Ste 400 West Palm Beach FL 33411-6742 | |
| (561) 294-8331 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2054 Vista Pkwy Ste 400, West Palm Beach, Florida |
| Authorized Official Name and Position | Johanne Joseph (FNP,PMHNP) |
| Authorized Official Contact | 5612948331 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
185 Rivera Ave Royal Palm Beach FL 33411-1005 Ph: (561) 294-8331 | 2054 Vista Pkwy Ste 400 West Palm Beach FL 33411-6742 Ph: (561) 294-8331 |
| NPI Number | 1881441624 |
|---|---|
| Provider Enumeration Date | 04/30/2024 |
| Last Update Date | 08/06/2024 |
| Certification Date | 08/06/2024 |
| Medicare PECOS PAC ID | 2567907587 |
|---|---|
| Medicare Enrollment ID | O20240715002905 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881441624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |
| Provider Name | Johanne Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679210025 PECOS PAC ID: 3476098492 Enrollment ID: I20240715003184 |
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