Provider Demographics
NPI:1174702492
Name:JOHNSON, JAMIE ANN (BSN)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 ALTAMONTE BAY CLUB CIR
Mailing Address - Street 2:#107
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5848
Mailing Address - Country:US
Mailing Address - Phone:407-834-1983
Mailing Address - Fax:
Practice Address - Street 1:283 ALTAMONTE BAY CLUB CIR
Practice Address - Street 2:#107
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5848
Practice Address - Country:US
Practice Address - Phone:407-834-1983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN900152163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse