Provider Demographics
NPI:1245364157
Name:JOHNSON, ANDREA COLETTE (ARNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:COLETTE
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 3614
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3614
Mailing Address - Country:US
Mailing Address - Phone:352-817-7622
Mailing Address - Fax:
Practice Address - Street 1:19204 NW US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-8783
Practice Address - Country:US
Practice Address - Phone:386-454-7746
Practice Address - Fax:386-454-3034
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9191956363LP2300X, 363LW0102X, 363LX0106X
FLARNP9191956363LX0106X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ47316Medicare UPIN