Provider Demographics
NPI:1891710034
Name:JOHNSON, ANN L (ARNP)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1947 19TH CT
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-9001
Mailing Address - Country:US
Mailing Address - Phone:561-422-6643
Mailing Address - Fax:561-422-7578
Practice Address - Street 1:7305 NORTH MILITARY TRAIL
Practice Address - Street 2:PRIMARY CARE (110)
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-422-7577
Practice Address - Fax:561-422-7615
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2071382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVADOOMedicare UPIN