Provider Demographics
NPI:1700660917
Name:JOHNSON, MADISON MARIE (PA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E ROMANA ST APT 325
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5839
Mailing Address - Country:US
Mailing Address - Phone:850-696-5799
Mailing Address - Fax:
Practice Address - Street 1:190 E INTENDENCIA ST # A-28
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5806
Practice Address - Country:US
Practice Address - Phone:850-908-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant