Provider Demographics
NPI:1780647180
Name:JOHNSON, KAREN GAIL SMITH (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:GAIL SMITH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
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 337
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425
Mailing Address - Country:US
Mailing Address - Phone:850-547-8500
Mailing Address - Fax:850-547-8515
Practice Address - Street 1:603 SCENIC CIRCLE
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425
Practice Address - Country:US
Practice Address - Phone:850-437-8500
Practice Address - Fax:850-547-8515
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1846312363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301077500Medicaid
R60202Medicare UPIN
FL301077500Medicaid