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General NPI Number Information
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NPI Number | 1578200275
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Entity Type | Individual
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Provider Name | LEAH MARY JOHNSON ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 115 PROFESSIONAL DR STE 101
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City | PONTE VEDRA
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State | FL
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Zip | 32082-6201
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Country | US
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Telephone | 904-686-7525
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Fax |
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Provider Business Mailing Address
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Address Line | 2158 FEATHERWOOD DR W
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City | JACKSONVILLE
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State | FL
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Zip | 32233-6921
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Country | US
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Telephone | 904-523-5313
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11018872
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11018872
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License Number State | FL
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