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General NPI Number Information
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NPI Number | 1427271907
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Entity Type | Individual
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Provider Name | MELODY MARIE JOHNSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 357 WEKIVA SPRINGS RD
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City | LONGWOOD
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State | FL
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Zip | 32779-3607
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Country | US
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Telephone | 407-862-1163
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Fax | 407-774-1877
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Provider Business Mailing Address
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Address Line | 1117 W SEAGATE DR
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City | DELTONA
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State | FL
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Zip | 32725-2214
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Country | US
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Telephone | 407-862-1163
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Fax | 407-774-1877
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3320
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License Number State | FL
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