MEDICARE: DR. DONNA CHERYLL JOHNSTON MD

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	207Q00000X	Family Medicine Physician	ME 76813	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49715	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7158131	OTHER	FL	AETNA INSURANCE

General Provider Information

NPI Number	:	1447253463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA CHERYLL JOHNSTON MD

Provider Business Mailing Address
First Line	:	8061 SPYGLASS HILL RD. SUITE 102
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940
Country	:	US
Telephone Number	:	321-751-7041
Fax Number	:	351-751-7042

Provider Business Practice Location Address
First Line	:	8061 SPYGLASS HILL RD. SUITE 102
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940
Country	:	US
Telephone Number	:	321-751-7041
Fax Number	:	351-751-7042

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/02/2015

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