=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609312610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR ERIKA LEIGH JOHNSON MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2017
-----------------------------------------------------
Last Update Date | 01/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12250 TAMIAMI TRL E SUITE 201
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34113-8108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-595-9939
-----------------------------------------------------
Fax | 888-711-3539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12250 TAMIAMI TRL E SUITE 201
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34113-8108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-595-9939
-----------------------------------------------------
Fax | 888-711-3539
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | MS. ERIKA LEIGH JOHNSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 239-595-9939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | ME124467
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------