Provider Demographics
NPI:1043558836
Name:JOHNS, GARRI RENEE (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:GARRI
Middle Name:RENEE
Last Name:JOHNS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:802 S 6TH ST
Practice Address - Street 2:UFJAX - CROSSROADS FAMILY MEDICINE
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-9608
Practice Address - Country:US
Practice Address - Phone:904-383-1780
Practice Address - Fax:904-383-1776
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9278608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009469800Medicaid
FLP01385809Medicare PIN
FLHN854ZMedicare PIN