Provider Demographics
NPI:1154294486
Name:JOHNSON, BRANDON LAMAR (NURSE)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LAMAR
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 HARTWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-7926
Mailing Address - Country:US
Mailing Address - Phone:689-290-6060
Mailing Address - Fax:407-386-6700
Practice Address - Street 1:3261 US 441
Practice Address - Street 2:SUITE B2
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731
Practice Address - Country:US
Practice Address - Phone:689-290-6060
Practice Address - Fax:407-386-6700
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5265165164W00000X
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse