| Johnson Riverside Family Practice Llc | |
|
43 Avenue J Moore Haven FL 33471 | |
| (863) 599-1620 | |
| Not Available |
| Full Name | Johnson Riverside Family Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 43 Avenue J, Moore Haven, Florida |
| Authorized Official Name and Position | Jennifer Nichole Johnson (APRN) |
| Authorized Official Contact | 8639460284 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Johnson Riverside Family Practice Llc 43 Avenue J Sw Moore Haven FL 33471-2116 Ph: (863) 946-0284 | Johnson Riverside Family Practice Llc 43 Avenue J Moore Haven FL 33471 Ph: (863) 599-1620 |
| NPI Number | 1295409423 |
|---|---|
| Provider Enumeration Date | 08/02/2021 |
| Last Update Date | 10/11/2022 |
| Medicare PECOS PAC ID | 5496152555 |
|---|---|
| Medicare Enrollment ID | O20210916002176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295409423 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Jennifer Nichole Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821691544 PECOS PAC ID: 6305243460 Enrollment ID: I20210920000079 |
Riverside Glades Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 51 Avenue J Sw, -mail Not Delivered To This Rural Address, Moore Haven, FL 33471 Phone: 863-946-1000 Fax: 863-946-1110 | |
Glades Convenient Care Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 51 Avenue J., Suite 101, Moore Haven, FL 33471 Phone: 863-946-1000 Fax: 863-946-1006 |