Individual
MARCIA M WISDOM-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
601 E ROLLINS ST, ORLANDO, FL 32803-1248
(407) 667-0444
(407) 667-4338
Mailing address
291 SOUTHHALL LN, SUITE 201, MAITLAND, FL 32751-7274
(407) 667-0444
(407) 667-4338
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP3359422
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
303009100
—
FL
01
—
G2505
BCBS
FL
Enumeration date
05/25/2006
Last updated
02/15/2008
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