Provider Demographics
NPI:1912711789
Name:JOHNSON, VANESSA ALTHEA (PHD PMHNP-BC APRN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ALTHEA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD PMHNP-BC APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 NW 80TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2482
Mailing Address - Country:US
Mailing Address - Phone:918-638-7858
Mailing Address - Fax:
Practice Address - Street 1:6403 NW 80TH DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-2482
Practice Address - Country:US
Practice Address - Phone:918-638-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029349363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health