Provider Demographics
NPI:1447310438
Name:JOHNSTON, VIRGINIA (FNP)
Entity type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-1209
Mailing Address - Country:US
Mailing Address - Phone:843-652-8220
Mailing Address - Fax:843-520-8365
Practice Address - Street 1:4040 HIGHWAY 17
Practice Address - Street 2:SUITE 104
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5098
Practice Address - Country:US
Practice Address - Phone:843-652-8150
Practice Address - Fax:843-652-8151
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2320OtherMEDICAL LICENSE
SC2320OtherMEDICAL LICENSE