MEDICARE: MS. MARSHA ANN WHITE-JOHNSON ARNP/FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-028925	AL
2	363LF0000X	Family Nurse Practitioner	ARNP1717092	FL

General Provider Information

NPI Number	:	1114908555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARSHA ANN WHITE-JOHNSON ARNP/FNP

Provider Business Mailing Address
First Line	:	103 W PARK PLACE AVE
Second Line	:
City	:	INLET BEACH
State	:	FL
Zip	:	32461-7227
Country	:	US
Telephone Number	:	850-866-1402
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 W PARK PLACE AVE
Second Line	:
City	:	INLET BEACH
State	:	FL
Zip	:	32461-7227
Country	:	US
Telephone Number	:	850-866-1402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	11/29/2017

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