| Doctor Name: | MRS. LISA MARIE JOHNSON |
| NPI Number: | 1295877785 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A. |
| License Number: | 1338 |
| Business Practice Address: | 150 5th Ave Suite C Indialantic, FL - 329033154 |
| Business Phone Number: | 3212546803 |
| Business Fax Number: | 3212546819 |
| Mailing Address: | 150 5th Ave, Suite C INDIALANTIC |
| State: | FL |
| Postal Code: | 329033154 |
| Phone Number: | 3212546803 |
| Fax Number: | 3212546819 |
| NPI Enumeration Date: | 02/13/2007 |
| NPI Last Update Date: | 05/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 1338 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |