Healthcare Provider Details

I. General information

NPI: 1679485247
Provider Name (Legal Business Name): KRISTINE MARY JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 95TH ST
SEBASTIAN FL
32958-6308
US

IV. Provider business mailing address

5510 95TH ST
SEBASTIAN FL
32958-6308
US

V. Phone/Fax

Practice location:
  • Phone: 980-254-2077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN9392721
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: