Provider Demographics
NPI:1821353350
Name:JOHANSSON, JANE (ARNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:JOHANSSON
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 1:858 KLINE ST
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-3773
Mailing Address - Country:US
Mailing Address - Phone:203-910-9650
Mailing Address - Fax:
Practice Address - Street 1:1400 N US HIGHWAY 441
Practice Address - Street 2:SUITE 552
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8975
Practice Address - Country:US
Practice Address - Phone:352-753-9777
Practice Address - Fax:352-753-9781
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9399755363L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program