Individual provider Active NPI

Nicole Briana Johnson, APRN

  • Adult Health Nurse Practitioner
  • Orlando, FL
National Provider Identifier
1639804966
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN11020786 Issued in FL
Practice address
1717 S Orange Ave Ste 103
Orlando, FL 32806-2946
Phone
(321) 841-4344
Fax
(321) 843-5550
NPI assigned
Jul 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11020786 FL
Adult Health Nurse Practitioner 363LA2200X APRN11020786 FL Primary

Addresses

Primary practice location

1717 S Orange Ave Ste 103
Orlando, FL 32806-2946

Mailing address

1717 S Orange Ave
Orlando, FL 32806-2944
Phone (321) 841-4344

Other practice location 1

590 Piazza Pt
Oviedo, FL 32765-5420
Phone (407) 312-3548

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230220002175 FL Practitioner - Nurse Practitioner 9638541659 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

1717 S Orange Ave
Suite 103
Orlando, FL 32806-2946
Phone (407) 236-0404

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN11020786FLMDAdult Health Nurse Practitioner
11020786FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hasan Shahab, M.D., P.a CurrentSince Jan 13, 2023 Accepting new patients
Nephrology Partners of Central Florida LLC CurrentSince Jan 13, 2023 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Aug 1, 2024 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Aug 1, 2024 Accepting new patients

Locations

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

1717 S Orange Ave
Orlando, FL 32806
Phone (407) 422-6798

10960 Dylan Loren Cir
Orlando, FL 32825
Phone (407) 420-7952

1717 S Orange Ave
Ste 103
Orlando, FL 32806
Phone (407) 236-0404

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1658275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1639804966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 S ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062944",
            "telephone_number": "321-841-4344",
            "fax_number": "321-841-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S ORANGE AVE STE 103",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062946",
            "telephone_number": "321-841-4344",
            "fax_number": "321-843-5550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "590 Piazza Pt",
            "address_purpose": "LOCATION",
            "city": "Oviedo",
            "state": "FL",
            "postal_code": "327655420",
            "country_code": "US",
            "telephone_number": "407-312-3548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICOLE",
        "middle_name": "BRIANA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-20",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11020786",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11020786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.