Provider Demographics
NPI:1982030276
Name:JOHNSON, CORLINA M (AGPCNP-BC, AAHIVS)
Entity type:Individual
Prefix:
First Name:CORLINA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AGPCNP-BC, AAHIVS
Other - Prefix:
Other - First Name:CORLINA
Other - Middle Name:
Other - Last Name:MCNEIL SOLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APCNP-BC
Mailing Address - Street 1:1501 CORPORATE DR STE 100-S6
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6600
Mailing Address - Country:US
Mailing Address - Phone:561-250-3595
Mailing Address - Fax:561-783-2207
Practice Address - Street 1:1501 CORPORATE DR STE 100-S6
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6600
Practice Address - Country:US
Practice Address - Phone:561-250-3595
Practice Address - Fax:561-783-2207
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9274792261QP2300X
FLARNP9274792363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117140000Medicaid