| Mrs Lisa Marie Johnson, PA | |
|
150 5th Ave Ste A, Indialantic, FL 32903-3154 | |
| (321) 254-6803 | |
| (321) 254-6819 |
| Full Name | Mrs Lisa Marie Johnson |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant - Medical |
| Location | 150 5th Ave Ste A, Indialantic, Florida |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295877785 | NPI | - | NPPES |
| 200028010A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | 1338 (Oklahoma) | Secondary |
| 363AM0700X | Physician Assistant - Medical | PA9108416 (Florida) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Mrs Lisa Marie Johnson, PA 150 5th Ave Ste A, Indialantic, FL 32903-3154 Ph: (321) 254-6803 | Mrs Lisa Marie Johnson, PA 150 5th Ave Ste A, Indialantic, FL 32903-3154 Ph: (321) 254-6803 |
Dale Phillip Greyslak, PAC Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 3491 Titanic Cir, Indialantic, FL 32903 Phone: 407-451-0192 | |
Casey Robert Runte, Physician Assistant Medicare: Medicare Enrolled Practice Location: 141 Coconut Dr, Indialantic, FL 32903 Phone: 321-610-8939 | |
Maxwell Clark Poling, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 420 5th Ave, Indialantic, FL 32903 Phone: 321-312-1352 Fax: 321-312-1513 |