Individual
BRETT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2401 FRIST BLVD STE 4, FORT PIERCE, FL 34950-4800
(772) 595-5302
(772) 595-5304
Mailing address
10463 HUNTERS HAVEN BLVD, RIVERVIEW, FL 33578-3363
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9116992
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922275866
—
FL
Enumeration date
02/02/2023
Last updated
02/02/2023
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