Provider Demographics
NPI:1538579115
Name:JOHNSON, GILLIAN KATHLEEN (ARNP)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:KATHLEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 SW 57TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5563
Mailing Address - Country:US
Mailing Address - Phone:352-222-4027
Mailing Address - Fax:
Practice Address - Street 1:8311 SW 57TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-5563
Practice Address - Country:US
Practice Address - Phone:352-222-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9247419363L00000X
FLARNP 9247419163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012192900Medicaid
FL012192900Medicaid