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General NPI Number Information
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NPI Number | 1164122792
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Entity Type | Individual
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Provider Name | MATTHEW KALEB JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 52 W UNDERWOOD ST
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City | ORLANDO
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State | FL
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Zip | 32806-1110
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Country | US
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Telephone | 321-841-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 GAGE AVE
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City | DELTONA
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State | FL
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Zip | 32738-7128
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 5271264
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License Number State | ID
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