Healthcare Provider Details

I. General information

NPI: 1780535013
Provider Name (Legal Business Name): HEATHERANN JOHNSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER-ANN A JOHNSON PMHNP-BC

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 STILLWOOD WAY
SAINT CLOUD FL
34771-8030
US

IV. Provider business mailing address

2206 STILLWOOD WAY
SAINT CLOUD FL
34771-8030
US

V. Phone/Fax

Practice location:
  • Phone: 646-322-6171
  • Fax:
Mailing address:
  • Phone: 646-322-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11045263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: