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NPI Code Detail

MEDICARE: KRISTIN JENISE JOHNSON

MEDICARE: KRISTIN JENISE JOHNSON
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
1390200000XStudent in an Organized Health Care Education/Training ProgramFL

General Provider Information

NPI Number : 1134070436
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN JENISE JOHNSON
Provider Business Mailing Address
First Line : 12988 SW 86TH UN
Second Line :
City : LAKE BUTLER
State : FL
Zip : 32054-7589
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6500 W NEWBERRY RD
Second Line :
City : GAINESVILLE
State : FL
Zip : 32605-4309
Country : US
Telephone Number : 904-263-2632
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2026
Last Update Date : 02/04/2026

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Directions to “ KRISTIN JENISE JOHNSON ” Practice Location

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