Provider Demographics
NPI:1427413822
Name:GORDON M JOHNSON ARNP, LLC
Entity Type:Organization
Organization Name:GORDON M JOHNSON ARNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:IV
Authorized Official - Credentials:ARNP/CRNA
Authorized Official - Phone:352-572-0427
Mailing Address - Street 1:3230 SE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-9309
Mailing Address - Country:US
Mailing Address - Phone:352-572-0427
Mailing Address - Fax:
Practice Address - Street 1:3230 SE 45TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-9309
Practice Address - Country:US
Practice Address - Phone:352-572-0427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9231283367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty