Provider Demographics
NPI:1891400693
Name:JOVANOVIC, JOHANNA (APRN)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:JOVANOVIC
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-6003
Mailing Address - Country:US
Mailing Address - Phone:727-347-2557
Mailing Address - Fax:
Practice Address - Street 1:3955 58TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-6003
Practice Address - Country:US
Practice Address - Phone:727-347-2557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11309172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117552200Medicaid
FLQJ531OtherHFMG MA