Individual
MR. ROBERT MATHEW JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
4898 ERIN LN, MELBOURNE, FL 32940-7156
(321) 536-4817
Mailing address
4898 ERIN LN, MELBOURNE, FL 32940-7156
(321) 536-4817
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN11005321
FL
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11005321
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L3639
MEDICARE PTAN
FL
Enumeration date
12/11/2019
Last updated
02/03/2020
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