MEDICARE: DR. VANESSA EMILY JOHNSON M.D.

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	207N00000X	Dermatology Physician	ME132429	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	JC290Z	OTHER	FL	MEDICARE

General Provider Information

NPI Number	:	1972948875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA EMILY JOHNSON M.D.

Provider Business Mailing Address
First Line	:	105 S BANANA RIVER BLVD FL 2
Second Line	:
City	:	COCOA BEACH
State	:	FL
Zip	:	32931-5041
Country	:	US
Telephone Number	:	321-200-0346
Fax Number	:

Provider Business Practice Location Address
First Line	:	389 COMMERCE PKWY STE 160
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4202
Country	:	US
Telephone Number	:	321-200-0346
Fax Number	:

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

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	04/02/2026

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