MEDICARE: MS. AMY JOHNSON CNM

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	367A00000X	Advanced Practice Midwife	1857322	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780633172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY JOHNSON CNM

Provider Business Mailing Address
First Line	:	6450 38TH AVE N
Second Line	:	SUITE 200
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-1645
Country	:	US
Telephone Number	:	727-344-6060
Fax Number	:	727-347-5586

Provider Business Practice Location Address
First Line	:	6450 38TH AVE N
Second Line	:	SUITE 200
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-1645
Country	:	US
Telephone Number	:	727-344-6060
Fax Number	:	727-347-5586

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	03/27/2012

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