Provider Demographics
NPI:1407899412
Name:JOHNSON, IVONNE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:
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 1:201 N PARK AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4147
Mailing Address - Country:US
Mailing Address - Phone:407-889-1953
Mailing Address - Fax:407-303-0845
Practice Address - Street 1:201 N PARK AVE STE 105
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4147
Practice Address - Country:US
Practice Address - Phone:407-889-1953
Practice Address - Fax:407-303-0845
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2171042363LP0200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
500017673OtherRAILROAD MEDICARE
FLY0033OtherBCBS
FL303832700Medicaid
500017673OtherRAILROAD MEDICARE
FLY0033OtherBCBS