Individual
MRS. LISA MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
150 5TH AVE STE A, INDIALANTIC, FL 32903-3154
(321) 254-6803
(321) 254-6819
Mailing address
150 5TH AVE STE A, INDIALANTIC, FL 32903-3154
(321) 254-6803
(321) 254-6819
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
1338
OK
363AM0700X
Medical Physician Assistant
Primary
PA9108416
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200028010A
—
OK
Enumeration date
02/13/2007
Last updated
03/28/2022
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