Provider Demographics
NPI:1487426078
Name:JOHNSON, HEATHER MARIE (APRN PMHNP-BC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5973 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-2607
Mailing Address - Country:US
Mailing Address - Phone:352-699-1424
Mailing Address - Fax:352-204-1611
Practice Address - Street 1:5973 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-2607
Practice Address - Country:US
Practice Address - Phone:352-699-1424
Practice Address - Fax:352-204-1611
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029402363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health