Provider Demographics
NPI:1518188754
Name:JOHNSON, BARBARA-ANNE (ANP)
Entity type:Individual
Prefix:
First Name:BARBARA-ANNE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ROBERT TOWNSEND DR
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1311
Mailing Address - Country:US
Mailing Address - Phone:631-265-7671
Mailing Address - Fax:631-265-7692
Practice Address - Street 1:100 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3502
Practice Address - Country:US
Practice Address - Phone:631-265-7671
Practice Address - Fax:631-265-7692
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301415-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP39538Medicare UPIN
NY2E3651Medicare ID - Type Unspecified