Healthcare Provider Details

I. General information

NPI: 1992953947
Provider Name (Legal Business Name): AMANDA J JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 06/13/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S BALDWIN AVE
ARCADIA FL
34266-3387
US

IV. Provider business mailing address

1031 E OAK ST
ARCADIA FL
34266-8923
US

V. Phone/Fax

Practice location:
  • Phone: 863-491-7580
  • Fax:
Mailing address:
  • Phone: 863-491-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9543236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: