MEDICARE: MS. CHERRON MICHELLE JOHNSON CRNA

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	363LF0000X	Family Nurse Practitioner	APRN9165972	FL
2	367500000X	Certified Registered Nurse Anesthetist	ARNP9165972	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295755833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERRON MICHELLE JOHNSON CRNA

Provider Business Mailing Address
First Line	:	PO BOX 850001
Second Line	:	DEPT 121
City	:	ORLANDO
State	:	FL
Zip	:	32885-0192
Country	:	US
Telephone Number	:	904-282-6331
Fax Number	:	904-282-4117

Provider Business Practice Location Address
First Line	:	4348 SOUTHPOINT BLVD STE 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-0903
Country	:	US
Telephone Number	:	904-281-1915
Fax Number	:	904-281-1119

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	04/08/2020

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