Active NPI
Johnna L Jackson, ARNP
- Nurse Practitioner
- Lake City, FL
National Provider Identifier
1639179435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- ARNP2552432
- Practice address
- 1847 SW Barnett Way
Lake City, FL 32025 - Phone
- (386) 755-2240
- Fax
- (386) 755-6598
- NPI assigned
- Jul 22, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | ARNP2552432 | FL | Primary |
Addresses
Primary practice location
1847 SW Barnett Way
Lake City, FL 32025
Mailing address
1847 SW Barnett Way
Lake City, FL 32025
Phone (386) 755-2240
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 301881400 | Medicaid | FL |
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
| License | State | Type | Specialty |
|---|---|---|---|
| ARNP2552432 | FL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242345600000",
"number": "1639179435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1847 SW BARNETT WAY",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "32025",
"telephone_number": "386-755-2240",
"fax_number": "386-755-6598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1847 SW BARNETT WAY",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "32025",
"telephone_number": "386-755-2240",
"fax_number": "386-755-6598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JOHNNA",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-22",
"last_updated": "2009-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "FL",
"license": "ARNP2552432",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "301881400",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.