Healthcare Provider Details

I. General information

NPI: 1295755833
Provider Name (Legal Business Name): CHERRON MICHELLE JOHNSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4348 SOUTHPOINT BLVD STE 100
JACKSONVILLE FL
32216-0903
US

IV. Provider business mailing address

PO BOX 850001 DEPT 121
ORLANDO FL
32885-0192
US

V. Phone/Fax

Practice location:
  • Phone: 904-281-1915
  • Fax: 904-281-1119
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-282-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9165972
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9165972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: