Healthcare Provider Details

I. General information

NPI: 1992934889
Provider Name (Legal Business Name): JEAN SANTER JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST STE 300
ORLANDO FL
32803-1468
US

IV. Provider business mailing address

615 E PRINCETON ST STE 300
ORLANDO FL
32803-1468
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-6005
  • Fax: 407-898-7722
Mailing address:
  • Phone: 407-898-6005
  • Fax: 407-898-7722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN2551282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: