Individual
NANCY JEAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
119 LONGWOOD AVE, ROCKLEDGE, FL 32955-2827
(321) 632-6963
(321) 632-6983
Mailing address
PO BOX 11406, BELFAST, ME 04915-4005
(321) 632-6963
(321) 632-6983
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME94649
FL
207RC0000X
Cardiovascular Disease Physician
ME94649
FL
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
ME94649
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274547000
—
FL
01
—
35193
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/28/2006
Last updated
04/15/2015
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