Provider Demographics
NPI:1093424616
Name:JOHNSON, AMBER CAMILLE (CNS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:CAMILLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8283 BAYMEADOWS RD E APT 1301
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3060
Mailing Address - Country:US
Mailing Address - Phone:313-595-8609
Mailing Address - Fax:
Practice Address - Street 1:8283 BAYMEADOWS RD E APT 1301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3060
Practice Address - Country:US
Practice Address - Phone:313-595-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012587364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology