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Provider Information for 1992180582

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

JOEL JOHNSON FNP-C

Gender: MALE

Individual NPI: 1992180582

Calendar   Last Updated:  2015-08-24
  Certification Date: 

Details

Name Value
NPI 1992180582
Enumeration Date 2015-07-23
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 3904 SADDLE RIDGE ST
VALRICO, FL 33596-8444
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 4315 HIGHLAND PARK BLVD STE A
LAKELAND, FL 33813-1639
United States

Phone: 863-816-5884 | Fax: 863-940-4856
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other MEDICARE LICENSE FL ARNP9212395
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family FL ARNP9212395