Individual
GORDON MACK JOHNSON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN/CRNA/FNP
Contact information
Practice address
1834 SW 1ST AVE STE 201, OCALA, FL 34471-8102
(352) 732-9888
Mailing address
PO BOX 918025, ORLANDO, FL 32891-8025
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN9231283
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9231283
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008994000
—
FL
Enumeration date
06/13/2013
Last updated
05/06/2022
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