Individual
GRACE ELIZABETH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9981 S HEALTHPARK DR, FORT MYERS, FL 33908-3618
(239) 343-5437
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-6260
(239) 343-6259
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9119447
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123827200
—
FL
Enumeration date
10/15/2024
Last updated
01/13/2025
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