Healthcare Provider Details

I. General information

NPI: 1801569413
Provider Name (Legal Business Name): AMBER RENEE JOHNSON APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13460 NC HIGHWAY 50 STE 104
SURF CITY NC
28445-6532
US

IV. Provider business mailing address

13460 NC HIGHWAY 50 STE 104
SURF CITY NC
28445-6532
US

V. Phone/Fax

Practice location:
  • Phone: 910-581-9136
  • Fax:
Mailing address:
  • Phone: 910-581-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5014359
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: