=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912283078
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNEKA CLARISE JOHNSON APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2011
-----------------------------------------------------
Last Update Date | 06/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1720 S GADSDEN ST
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32301-5506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-576-4073
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1115 W CALL ST
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32306-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-644-1543
-----------------------------------------------------
Fax | 850-645-0577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 9251342
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------