Provider Demographics
NPI:1295902799
Name:JOHNSON, LORENA ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 NICHOLSON ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9440
Mailing Address - Country:US
Mailing Address - Phone:850-994-7755
Mailing Address - Fax:
Practice Address - Street 1:3425 NICHOLSON ESTATES RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-9440
Practice Address - Country:US
Practice Address - Phone:850-994-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3103292163WH1000X, 163WM0705X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WX0200XNursing Service ProvidersRegistered NurseOncology