Provider Demographics
NPI:1316265994
Name:JOHNSON, KRISTA (APRN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:LIPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:260 NW PEACOCK BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2349
Mailing Address - Country:US
Mailing Address - Phone:772-878-7216
Mailing Address - Fax:772-878-7218
Practice Address - Street 1:2398 SE OCEAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3310
Practice Address - Country:US
Practice Address - Phone:772-419-4834
Practice Address - Fax:772-419-4833
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9259102363LP0808X
FLAPRN9259102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9259102OtherAMERICAN ACADEMY NURSE PRACTITIONER