Healthcare Provider Details

I. General information

NPI: 1922826122
Provider Name (Legal Business Name): ANNETTE LYNN JOHNSON LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 MARINER BLVD
SPRING HILL FL
34609-3859
US

IV. Provider business mailing address

2120 MARINER BLVD
SPRING HILL FL
34609-3859
US

V. Phone/Fax

Practice location:
  • Phone: 813-377-2229
  • Fax:
Mailing address:
  • Phone: 813-377-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM24090563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: