Provider Demographics
NPI:1982411153
Name:JOHNSON, MIKAELA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 WAR ADMIRAL DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-1567
Mailing Address - Country:US
Mailing Address - Phone:786-760-1226
Mailing Address - Fax:
Practice Address - Street 1:5602 WAR ADMIRAL DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-1567
Practice Address - Country:US
Practice Address - Phone:786-760-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031567363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125666500Medicaid
FL3NBKNOtherBCBS