Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APRN11003302 | FL |
Y | 363LA2200X | Nurse Practitioner - Adult Health | APRN11003302 | FL |
N | 363LP2300X | Nurse Practitioner - Primary Care | APRN11003302 | FL |
NPI | 1003469412 |
---|---|
Provider Name | Dr. Ashley Brooke Austin Johnson |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33612-6601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2019 |
Last Update Date | 28/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104089100 | (05) | FL |
LQ7QK | BLUE CROSS BLUE SHIELD (01) | FL |