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NPI Code Detail

MEDICARE: MONA R JOHNSON CRNA

MEDICARE: MONA R JOHNSON CRNA
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
1367500000XCertified Registered Nurse Anesthetist1023968AL
2367500000XCertified Registered Nurse AnesthetistARNP9281201FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G900GOTHERFLBLUE CROSS BLUE SHIELD OF FLORIDA

General Provider Information

NPI Number : 1205813383
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONA R JOHNSON CRNA
Provider Business Mailing Address
First Line : 1600 JENKS AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4644
Country : US
Telephone Number : 850-763-6666
Fax Number : 850-763-6665
Provider Business Practice Location Address
First Line : 1600 JENKS AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4644
Country : US
Telephone Number : 850-763-6666
Fax Number : 850-763-6665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 09/08/2009

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Directions to “ MONA R JOHNSON CRNA” Practice Location

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