Healthcare Provider Details

I. General information

NPI: 1629467352
Provider Name (Legal Business Name): GARY JOHNSTON JR. DNP, APRN-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 01/12/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N BYRON BUTLER PKWY
PERRY FL
32347-2300
US

IV. Provider business mailing address

8136 VIBURNUM CT
TALLAHASSEE FL
32312-5701
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-0800
  • Fax:
Mailing address:
  • Phone: 850-728-1179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN9205099
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9205099
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: