Individual provider Active NPI

Brandon Lamar Johnson, NURSE

  • Home Health Agency
  • Fruitland Park, FL
National Provider Identifier
1154294486
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Practice address
3261 US 441
Suite B2
Fruitland Park, FL 34731
Phone
(689) 290-6060
Fax
(407) 386-6700
NPI assigned
Sep 24, 2025
Last updated
Sep 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X PN5265165 FL
Home Health Agency 251E00000X FL Primary

Addresses

Primary practice location

3261 US 441
Suite B2
Fruitland Park, FL 34731

Mailing address

5252 Hartwood Loop
Wildwood, FL 34785-7926
Phone (689) 290-6060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PN5265165FLMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Divinely Chosen Services Home Health CurrentSince Sep 28, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1154294486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5252 HARTWOOD LOOP",
            "city": "WILDWOOD",
            "state": "FL",
            "postal_code": "347857926",
            "telephone_number": "689-290-6060",
            "fax_number": "407-386-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3261 US 441",
            "address_2": "SUITE B2",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "34731",
            "telephone_number": "689-290-6060",
            "fax_number": "407-386-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRANDON",
        "middle_name": "LAMAR",
        "credential": "NURSE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-09-24",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN5265165",
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fruitland Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.