Individual ProviderJeanine Daiana JohnsonNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address18962 SW 94th Ave, Cutler Bay, FL 33157-7958(305) 510-0276PECOS EnrollmentBased on the most recent information from CMS, provider Jeanine Daiana Johnson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1376188367Provider TypeIndividualFull NameJohnson, Jeanine DaianaGenderFemaleSole ProprietorNoEnumeration Date11/13/2019Last Updated11/13/2019Contact InformationPractice LocationPractice Address18962 SW 94th Ave, Cutler Bay, FL 33157-7958Phone(305) 510-0276FaxUnlisted FaxMailing LocationMailing Address18962 SW 94th Ave, Cutler Bay, FL 33157-7958Phone(305) 510-0276FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense11004730Florida