Healthcare Provider Details

I. General information

NPI: 1699346379
Provider Name (Legal Business Name): VASILINA JOHNSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 COLLINGTON RD STE 230
BOWIE MD
20716-2261
US

IV. Provider business mailing address

4880 BIG ISLAND DR # 3
JACKSONVILLE FL
32246-7490
US

V. Phone/Fax

Practice location:
  • Phone: 201-815-3466
  • Fax:
Mailing address:
  • Phone: 904-750-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11028575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: