Individual
DEREK A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
701 NW 13TH ST FL 3, BOCA RATON, FL 33486-2305
(561) 955-5790
(561) 955-5791
Mailing address
701 NW 13TH ST FL 3, BOCA RATON, FL 33486-2305
(561) 955-5790
(561) 955-5791
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9106805
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1039541
FREEDOM
FL
01
—
3011968
CIGNA
FL
01
—
398531
AVMED
FL
01
—
4179920
AETNA
FL
01
—
974430
OPTIMUM
FL
01
—
IFS7Z
BCBS
FL
01
—
P01707166
RR MEDICARE
FL
Enumeration date
11/15/2012
Last updated
03/18/2022
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