Healthcare Provider Details

I. General information

NPI: 1992284103
Provider Name (Legal Business Name): KRISTIN MARIE JOHNSON ARNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HIGHLAND PARK BLVD SUITE A
LAKELAND FL
33813
US

IV. Provider business mailing address

4315 HIGHLAND PARK BLVD SUITE A
LAKELAND FL
33813
US

V. Phone/Fax

Practice location:
  • Phone: 863-816-5884
  • Fax: 863-940-4856
Mailing address:
  • Phone: 863-816-5884
  • Fax: 863-940-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9372403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: