MEDICARE: DEBORAH R JOHNSON-EADY APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	APRN11029023	FL

General Provider Information

NPI Number	:	1053184143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH R JOHNSON-EADY APRN

Provider Business Mailing Address
First Line	:	5454 CENTRAL AVE STE A
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33707-6129
Country	:	US
Telephone Number	:	727-347-5242
Fax Number	:	727-347-2402

Provider Business Practice Location Address
First Line	:	5454 CENTRAL AVE STE A
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33707-6129
Country	:	US
Telephone Number	:	727-347-5242
Fax Number	:	727-347-2402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	11/01/2023

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