| Doctor Name: | MR. JON DAVID JOHNSON |
| NPI Number: | 1730179698 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ARNP |
| License Number: | 9197452 |
| Business Practice Address: | 495 E Main St Lake Butler, FL - 320541731 |
| Business Phone Number: | 3864963211 |
| Business Fax Number: | 3864961599 |
| Mailing Address: | 12049 Sw 76th Ter, LAKE BUTLER |
| State: | FL |
| Postal Code: | 320547724 |
| Phone Number: | 3864964428 |
| Fax Number: | |
| NPI Enumeration Date: | 10/24/2005 |
| NPI Last Update Date: | 10/31/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 9197452 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |