Healthcare Provider Details

I. General information

NPI: 1255699484
Provider Name (Legal Business Name): CHRISTINE G. JOHNSON ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NORTHSIDE DR SUITE 702
PANAMA CITY FL
32405
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-1431
US

V. Phone/Fax

Practice location:
  • Phone: 850-770-3210
  • Fax: 850-770-3215
Mailing address:
  • Phone: 361-572-0333
  • Fax: 361-371-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9213650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: