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General NPI Number Information
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NPI Number | 1316265994
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Entity Type | Individual
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Provider Name | KRISTA JOHNSON APRN
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Gender | Female
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 2398 SE OCEAN BLVD STE A
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City | STUART
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State | FL
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Zip | 34996-3310
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Country | US
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Telephone | 772-419-4834
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Fax | 772-419-4833
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Provider Business Mailing Address
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Address Line | 260 NW PEACOCK BLVD STE 102
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2349
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Country | US
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Telephone | 772-878-7216
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Fax | 772-878-7218
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 9259102
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9259102
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License Number State | FL
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