Healthcare Provider Details

I. General information

NPI: 1710831417
Provider Name (Legal Business Name): JAMIE JOHNSON APRN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 N HIGHWAY 27
SEBRING FL
33870-1043
US

IV. Provider business mailing address

4306 MACKEREL DR
SEBRING FL
33870-8471
US

V. Phone/Fax

Practice location:
  • Phone: 863-214-9894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: