Provider Demographics
NPI:1215459763
Name:WELLINGTON, JOHANNA BLANCAFLOR (APRN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:BLANCAFLOR
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:BLANCAFLOR
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP-BC, NP-C
Mailing Address - Street 1:3715 TUCKERTON DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-8185
Mailing Address - Country:US
Mailing Address - Phone:813-695-8109
Mailing Address - Fax:
Practice Address - Street 1:3715 TUCKERTON DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-8185
Practice Address - Country:US
Practice Address - Phone:813-695-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024240363LF0000X
VA0024175029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily