Healthcare Provider Details

I. General information

NPI: 1821562570
Provider Name (Legal Business Name): BRITTNAI JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 02/22/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W 20TH ST
JACKSONVILLE FL
32254-1703
US

IV. Provider business mailing address

PO BOX 19249
JACKSONVILLE FL
32245-9249
US

V. Phone/Fax

Practice location:
  • Phone: 904-695-9145
  • Fax: 904-695-2465
Mailing address:
  • Phone: 904-743-1883
  • Fax: 904-695-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11001229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: