Healthcare Provider Details

I. General information

NPI: 1114908555
Provider Name (Legal Business Name): MARSHA ANN WHITE-JOHNSON ARNP/FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W PARK PLACE AVE
INLET BEACH FL
32461-7227
US

IV. Provider business mailing address

103 W PARK PLACE AVE
INLET BEACH FL
32461-7227
US

V. Phone/Fax

Practice location:
  • Phone: 850-866-1402
  • Fax:
Mailing address:
  • Phone: 850-866-1402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-028925
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP1717092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: