Individual
JONATHAN FRANKLIN JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
428 COLUMBUS AVENUE, PEDIATRICS, NEW HAVEN, CT 06519-1233
(203) 503-3030
(203) 503-3599
Mailing address
400 COLUMBUS AVENUE, CREDENTIALING SPECIALIST, NEW HAVEN, CT 06519-2613
(203) 503-3000
(203) 503-6515
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
119709
CT
363LF0000X
Family Nurse Practitioner
1-167832
AL
363LF0000X
Family Nurse Practitioner
Primary
8521
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235900
—
CT
Enumeration date
01/24/2018
Last updated
10/15/2019
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