Provider Demographics
NPI:1326682188
Name:JOHNSON, MILDRED MARIA (APRN)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:MARIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4024
Mailing Address - Country:US
Mailing Address - Phone:407-944-5240
Mailing Address - Fax:407-944-5251
Practice Address - Street 1:1300 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4024
Practice Address - Country:US
Practice Address - Phone:407-944-5240
Practice Address - Fax:407-944-5251
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily