Provider Demographics
NPI:1174092001
Name:COMPLETE SERENITY INC
Entity type:Organization
Organization Name:COMPLETE SERENITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:PAULETTE
Authorized Official - Last Name:JOHNSON-HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:954-783-8300
Mailing Address - Street 1:4225 SW 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2777
Mailing Address - Country:US
Mailing Address - Phone:954-783-8300
Mailing Address - Fax:954-783-8302
Practice Address - Street 1:721 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6345
Practice Address - Country:US
Practice Address - Phone:954-783-8300
Practice Address - Fax:954-783-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty