1962541433 NPI number — MS. ROBYN ANN POLINER-JOHNSON PA-C

Table of content: MS. ROBYN ANN POLINER-JOHNSON PA-C (NPI 1962541433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962541433 NPI number — MS. ROBYN ANN POLINER-JOHNSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLINER-JOHNSON
Provider First Name:
ROBYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962541433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
219 S K ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33460-4130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-393-4409
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2015 OCEAN DR
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33426-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-364-8056
Provider Business Practice Location Address Fax Number:
561-364-8507
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA9103590 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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