Individual
AUDREY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
12901 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4742
(813) 974-8926
Mailing address
1043 UNION ST, CLEARWATER, FL 33755-1046
(757) 642-8701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/15/2024
Last updated
04/15/2024
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