Healthcare Provider Details

I. General information

NPI: 1346932688
Provider Name (Legal Business Name): JAIMEE NICOLE JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 07/13/2024
Certification Date: 07/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10483 FGCU BLVD S
FORT MYERS FL
33965-0001
US

IV. Provider business mailing address

19415 SKIDMORE WAY APT 204
ESTERO FL
33967-4878
US

V. Phone/Fax

Practice location:
  • Phone: 954-240-6386
  • Fax:
Mailing address:
  • Phone: 954-240-6386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11033189
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9364069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: