Healthcare Provider Details

I. General information

NPI: 1396773917
Provider Name (Legal Business Name): MISTY JOAN JOHNSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5045 CARPENTER CREEK DR
PENSACOLA FL
32503-2521
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2400
  • Fax: 850-416-2467
Mailing address:
  • Phone: 850-416-2400
  • Fax: 850-416-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9371944
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: