Provider Demographics
NPI:1225120926
Name:JOHNSON, JENNIFER A (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
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 812364
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33481-2364
Mailing Address - Country:US
Mailing Address - Phone:561-997-0821
Mailing Address - Fax:561-997-0849
Practice Address - Street 1:2300 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1538
Practice Address - Country:US
Practice Address - Phone:561-997-0821
Practice Address - Fax:561-997-0849
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42435207RC0200X, 207RP1001X
TXM4215207RC0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100030980OtherKENTUCKY MEDICAID
9715313OtherAETNA
P00635226OtherRAILROAD MEDICARE
TX184042301Medicaid
TN3001422Medicaid
TN4181921OtherBCBS
TX8U1128OtherBCBS
TX184042302Medicaid
KY7100030980OtherKENTUCKY MEDICAID
TN4181921OtherBCBS
TX8U1128OtherBCBS
TX184042302Medicaid
TXP01072207Medicare PIN