MEDICARE: SAMANTHA PEARL JOHNSON NURSE PRACTITIONER IN PSYCHIATRY

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1770442196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMANTHA PEARL JOHNSON NURSE PRACTITIONER IN PSYCHIATRY

Provider Business Mailing Address
First Line	:	1408 BROOKLYN AVE APT 5E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-1875
Country	:	US
Telephone Number	:	330-390-0840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 BROOKLYN AVE APT 5E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-1875
Country	:	US
Telephone Number	:	330-390-0840
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	SAMANTHA PEARL JOHNSON
Credential	:	PMHNP
Telephone Number	:	330-390-0840

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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