Individual provider Active NPI

Caspertine Johnson

  • Family Nurse Practitioner
  • Live Oak, FL
National Provider Identifier
1306502083
Registry record updated Mar 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN302027 Issued in GA
Practice address
1101 Ohio Ave S
Live Oak, FL 32064-4146
Phone
(386) 339-1060
NPI assigned
Nov 16, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN11016170 FL
Family Nurse Practitioner 363LF0000X RN302027 GA Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN11016170 FL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN302027 GA

Addresses

Primary practice location

1101 Ohio Ave S
Live Oak, FL 32064-4146

Mailing address

PO Box 5922
Valdosta, GA 31603-5922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11016170FLMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Chirotherapy PLLC Family CurrentSince Jan 27, 2022 Accepting new patients
Rural Urgent Care LLC CurrentSince Dec 11, 2021 Accepting new patients
Grow Healthcare Group PA Psychiatric/Mental Health CurrentSince Feb 14, 2025 Accepting new patients
Marion Internal Medicine Associates CurrentSince Aug 7, 2022 Accepting new patients
Focus Healthcare PA CurrentSince Aug 7, 2022 Accepting new patients
Rural Urgent Care LLC CurrentSince Dec 11, 2021 Accepting new patients

Locations

1500 1st Ave N
Unit 3
Birmingham, AL 35203
Phone (205) 545-5088

126 SW Sumatra Ave
Unit C
Madison, FL 32340
Phone (850) 253-2326

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

1805 SE Lake Weir Ave
Ste B
Ocala, FL 34471
Phone (352) 629-9634

1408 Tallahassee Hwy
Ste Z
Bainbridge, GA 39819
Phone (229) 400-9033

1245 Noah Dr
Jasper, GA 30143
Phone (706) 253-1954

14336 US Highway 19 S
Thomasville, GA 31757
Phone (229) 233-6705

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1637020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1306502083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5922",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316035922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 OHIO AVE S",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320644146",
            "telephone_number": "386-339-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CASPERTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-16",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11016170",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN302027",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11016170",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN302027",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Live Oak, FL

Sources for this page

Verify at the official NPI Registry.