MEDICARE: ANTOINETTE MARIE JOHNSON CNP

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	APRN.CNP.0028361	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760153357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE MARIE JOHNSON CNP

Provider Business Mailing Address
First Line	:	2912 SPRINGBORO W STE 201
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	4403 W FRANKLIN ST STE D
Second Line	:
City	:	BELLBROOK
State	:	OH
Zip	:	45305-2700
Country	:	US
Telephone Number	:	937-848-9010
Fax Number	:

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

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	05/28/2026

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