Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME144527 | FL |
N | 2080A0000X | Adolescent Medicine | 00004512 | AL |
NPI | 1083680615 |
---|---|
Provider Name | Dr. Jennifer C Allen Johnson |
First Address | Fort Walton Beach, FL 32547-6707 |
Second Address | Navarre, FL 32566-2216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 27/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009965240 | (05) | AL |
D84031 | (02) | AL |