Provider Demographics
NPI:1639804966
Name:JOHNSON, NICOLE BRIANA (APRN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BRIANA
Last Name:JOHNSON
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 1:1717 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2944
Mailing Address - Country:US
Mailing Address - Phone:321-841-4344
Mailing Address - Fax:321-841-4344
Practice Address - Street 1:1717 S ORANGE AVE STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:321-841-4344
Practice Address - Fax:321-843-5550
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020786363LF0000X
FLAPRN11020786363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily