Healthcare Provider Details

I. General information

NPI: 1053077628
Provider Name (Legal Business Name): ANGELA JOHNSON REGISTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 QUINCY AVE
FORT PIERCE FL
34947-4766
US

IV. Provider business mailing address

16 SW CABANA POINT CIR
STUART FL
34994-4803
US

V. Phone/Fax

Practice location:
  • Phone: 772-302-9580
  • Fax: 772-302-9582
Mailing address:
  • Phone: 919-524-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11015985
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11015985
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: