| Doctor Name: | MRS. CARLY NICOLE JOHNSON |
| NPI Number: | 1033580550 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP, FNP-C |
| License Number: | ARNP9321326 |
| Business Practice Address: | 6600 Madison St New Port Richey, FL - 346521971 |
| Business Phone Number: | 7277346888 |
| Business Fax Number: | |
| Mailing Address: | 6600 Madison Ave, NEW PORT RICHEY |
| State: | FL |
| Postal Code: | 34652 |
| Phone Number: | 7277346888 |
| Fax Number: | |
| NPI Enumeration Date: | 10/09/2015 |
| NPI Last Update Date: | 10/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ARNP9321326 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |