Healthcare Provider Details

I. General information

NPI: 1750601035
Provider Name (Legal Business Name): CAROLYN ELIZABETH JOHNSTONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 STATE ROAD 54
NEW PORT RICHEY FL
34655-1808
US

IV. Provider business mailing address

18167 US 19 N
CLEARWATER FL
33764-3528
US

V. Phone/Fax

Practice location:
  • Phone: 727-834-4000
  • Fax:
Mailing address:
  • Phone: 727-507-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME 116380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: