Provider Demographics
NPI:1992026967
Name:JOHNSON, LAUREN P (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:P
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 1:8075 GATE PARKWAY W
Mailing Address - Street 2:SUITE 305
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-269-2992
Mailing Address - Fax:904-296-2993
Practice Address - Street 1:8075 GATE PARKWAY W
Practice Address - Street 2:SUITE 305
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-269-2992
Practice Address - Fax:904-296-2993
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9247061174400000X
NC5004832363LF0000X
FLAPRN9247061363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No174400000XOther Service ProvidersSpecialist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004876400Medicaid