Healthcare Provider Details

I. General information

NPI: 1518408483
Provider Name (Legal Business Name): SAMANTHA CAMILLE JOHNSON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3256 S PINE AVE
OCALA FL
34471-6605
US

IV. Provider business mailing address

3256 S PINE AVE
OCALA FL
34471-6605
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1919
  • Fax:
Mailing address:
  • Phone: 352-401-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: