Johnson, Mary
Johnson, Mary is an individual health care provider with primary practice located at 7575 Osceola Polk Line Rd , Davenport FL 33896-9112. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Johnson, Mary can be contacted via phone (321) 677-0531.Contact Information
Primary practice address
7575 Osceola Polk Line Rd
Davenport FL 33896-9112
Phone: (321) 677-0531
Fax: (321) 677-0537
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 1466102 | Florida |
Profile Details
| NPI number | 1750345898 |
|---|---|
| LBN Legal business name | Johnson, Mary |
| Credentials | ARNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 14th, 2006 |
| Last updated | Sep 1st, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750345898 | NPPES |
| Florida | MEDICAID | 304941800 |
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