MEDICARE: ELIZABETH ANN JOHNSON 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	209020571	IL

General Provider Information

NPI Number	:	1669004081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN JOHNSON FNP

Provider Business Mailing Address
First Line	:	1600 W WALNUT ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1199
Country	:	US
Telephone Number	:	217-479-5729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 W WALNUT ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-1136
Country	:	US
Telephone Number	:	217-602-1595
Fax Number	:

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

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	04/02/2026

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