Provider Demographics
NPI:1285001891
Name:JOHNSON, LORI (APN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 LAKE LUCIEN DR STE 112
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7233
Mailing Address - Country:US
Mailing Address - Phone:321-207-9029
Mailing Address - Fax:844-410-7960
Practice Address - Street 1:2600 LAKE LUCIEN DR STE 112
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751
Practice Address - Country:US
Practice Address - Phone:321-207-9029
Practice Address - Fax:844-410-7960
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128798363L00000X
FLAPRN9485019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner