Healthcare Provider Details

I. General information

NPI: 1740191642
Provider Name (Legal Business Name): ERIC JOHNSON APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 KEVSTIN DR
KISSIMMEE FL
34744-5800
US

IV. Provider business mailing address

1080 KEVSTIN DR
KISSIMMEE FL
34744-5800
US

V. Phone/Fax

Practice location:
  • Phone: 407-553-6336
  • Fax:
Mailing address:
  • Phone: 407-553-6336
  • Fax: 321-445-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11051017
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: