Individual
GLORIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2415 N ORANGE AVE STE 502, ORLANDO, FL 32804-5503
(407) 303-2805
(407) 303-2801
Mailing address
9535 VERONA LAKES BLVD, BOYNTON BEACH, FL 33472-2759
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9119046
FL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
01/10/2022
Last updated
10/15/2024
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