1760693022 NPI number — MRS. STEPHANIE KATE JOHNS MSN, APRN-BC

Table of content: MRS. STEPHANIE KATE JOHNS MSN, APRN-BC (NPI 1760693022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760693022 NPI number — MRS. STEPHANIE KATE JOHNS MSN, APRN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNS
Provider First Name:
STEPHANIE
Provider Middle Name:
KATE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FINNELL
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
KATE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, APRN FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760693022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10870 US-1 STE 4 (URGENT CARE CURE)
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONTE VEDRA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-438-2720
Provider Business Mailing Address Fax Number:
904-547-2368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URGENT CARE CURE
Provider Second Line Business Practice Location Address:
10870 US-1 STE 4
Provider Business Practice Location Address City Name:
PONTE VEDRA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-438-2720
Provider Business Practice Location Address Fax Number:
904-547-2368
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP3139582 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3139582 . This is a "ARNP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 013207900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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