Provider Demographics
NPI:1578595484
Name:JOHNSON, STEPHEN PAUL (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CRNA
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 2499
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34451-2499
Mailing Address - Country:US
Mailing Address - Phone:352-344-5201
Mailing Address - Fax:352-344-3822
Practice Address - Street 1:131 S CITRUS AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4701
Practice Address - Country:US
Practice Address - Phone:352-344-5201
Practice Address - Fax:352-344-3822
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2195622367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1326OtherBLUE CROSS
FL2195622OtherLICENSE
FL20923OtherAANA RE-CERT
FLG1326OtherBLUE CROSS