Healthcare Provider Details

I. General information

NPI: 1083680615
Provider Name (Legal Business Name): JENNIFER C ALLEN JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER CLAIRE ALLEN MD

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8990 NAVARRE PARKWAY PEDIATRIC DEPARTMENT
NAVARRE FL
32566-2216
US

IV. Provider business mailing address

1005 MAR WALT DRIVE ADMINISTRATION
FORT WALTON BEACH FL
32547-6707
US

V. Phone/Fax

Practice location:
  • Phone: 850-396-0108
  • Fax: 850-939-4933
Mailing address:
  • Phone: 850-863-8100
  • Fax: 850-863-4152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number00004512
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME144527
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: