Provider Demographics
NPI:1407434509
Name:JOHNSON, LINDSEY ANN
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 CORPORATE CENTER PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8088
Mailing Address - Country:US
Mailing Address - Phone:904-245-8910
Mailing Address - Fax:
Practice Address - Street 1:6675 CORPORATE CENTER PKWY STE 112
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8088
Practice Address - Country:US
Practice Address - Phone:321-652-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant