Provider Demographics
NPI:1326460775
Name:BRINER-JOHNSON, ANDREA J (ARNP, FNP-C, PMHNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:BRINER-JOHNSON
Suffix:
Gender:F
Credentials:ARNP, FNP-C, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SE HILLMOOR DR STE C103C104
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7553
Mailing Address - Country:US
Mailing Address - Phone:772-742-2411
Mailing Address - Fax:772-210-5087
Practice Address - Street 1:1801 SE HILLMOOR DR STE C103C104
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7553
Practice Address - Country:US
Practice Address - Phone:772-742-2111
Practice Address - Fax:772-210-5087
Is Sole Proprietor?:No
Enumeration Date:2014-01-19
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9268573363LF0000X
FLARPN9268573363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily