Provider Demographics
NPI:1760911044
Name:JOHNSON, JENNIFER ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:MORSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CATC-3N
Mailing Address - Street 1:24953 PASEO DE VALENCIA STE 7A
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4342
Mailing Address - Country:US
Mailing Address - Phone:949-829-2779
Mailing Address - Fax:949-339-3009
Practice Address - Street 1:24902 MOULTON PKWY STE 120
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92637-6403
Practice Address - Country:US
Practice Address - Phone:949-829-2779
Practice Address - Fax:949-339-3009
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1911966101YA0400X
CA719740163W00000X
CAF11220446363L00000X
CA95023410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner