Individual
SUSAN R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
501 6TH AVE S, ST PETERSBURG, FL 33701-4634
(727) 767-8181
(727) 767-8030
Mailing address
501 6TH AVE S, ST PETERSBURG, FL 33701-4634
(727) 767-8181
(727) 767-8030
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
ARNP3072252
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
303458500
—
FL
01
—
Y012G
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/08/2006
Last updated
02/10/2016
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