Provider Demographics
NPI:1932831765
Name:JOHNSON, OLIVIA A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12327 RICHARDS GLEN CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-3495
Mailing Address - Country:US
Mailing Address - Phone:904-790-3824
Mailing Address - Fax:
Practice Address - Street 1:12327 RICHARDS GLEN CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-3495
Practice Address - Country:US
Practice Address - Phone:904-790-3824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily