Provider Demographics
NPI:1831389147
Name:JOHNSON, SUSAN KAY (ARNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KAY
Other - Last Name:BRINKMIER ; REGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1745 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1876
Mailing Address - Country:US
Mailing Address - Phone:407-841-7151
Mailing Address - Fax:407-872-1336
Practice Address - Street 1:1745 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1876
Practice Address - Country:US
Practice Address - Phone:407-841-7151
Practice Address - Fax:407-872-1336
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3300172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF975ZMedicare PIN