Individual
BENJAMIN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1200 7TH AVE N, ST PETERSBURG, FL 33705-1300
(727) 825-1100
Mailing address
645 OLD HICKORY BLVD APT 927, NASHVILLE, TN 37209-5258
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R891524
MS
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN11000613
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN11000613
FL CRNA LICENSE
FL
Enumeration date
10/23/2018
Last updated
01/09/2019
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