MEDICARE: JENNIFER LYNN JOHNSTON FNP

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	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	95017640	CA

General Provider Information

NPI Number	:	1407428089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN JOHNSTON FNP

Provider Business Mailing Address
First Line	:	1905 CALLE BARCELONA STE 216
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-8452
Country	:	US
Telephone Number	:	760-274-6920
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 CALLE BARCELONA STE 216
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-8452
Country	:	US
Telephone Number	:	760-274-6920
Fax Number	:

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

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	07/13/2021

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