Provider Demographics
NPI:1962410753
Name:O'NEILL JOHNSON, MARY K (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:O'NEILL JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 WEKIVA COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3645
Mailing Address - Country:US
Mailing Address - Phone:407-464-9519
Mailing Address - Fax:407-464-9519
Practice Address - Street 1:515 WEKIVA COMMONS CIR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-3645
Practice Address - Country:US
Practice Address - Phone:407-464-9516
Practice Address - Fax:407-464-9519
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1275592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266648100Medicaid
FLY9754OtherBLUECROSSBLUESHIELD
FL305934100Medicaid
FLE4645AMedicare PIN
FL305934100Medicaid