Provider Demographics
NPI:1437476058
Name:JOHNSON, LINDA ALINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ALINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-475-4623
Mailing Address - Fax:
Practice Address - Street 1:1549 AIRPORT BLVD STE 320
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8635
Practice Address - Country:US
Practice Address - Phone:850-416-2500
Practice Address - Fax:850-416-2553
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9391377363L00000X
ALCRNP1-025250363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1647G1Medicare PIN
NY1647G1Medicare PIN