Healthcare Provider Details

I. General information

NPI: 1104299056
Provider Name (Legal Business Name): FAITH E JOHNSON ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 6TH ST SE
WINTER HAVEN FL
33880-4605
US

IV. Provider business mailing address

1601 SIXTH ST SE
WINTER HAVEN FL
33880-4605
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-9301
  • Fax:
Mailing address:
  • Phone: 863-419-9301
  • Fax: 863-419-9304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2970562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: