# SUDINE JOHNSON

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659726750
- **Authorized official:** SUDINE S JOHNSON (CNA)
- **Authorized official phone:** (321) 663-8247

## Contact information

- **Practice address:** 1230 W POINTE VILLAS BLVD BLDG APT 203, WINTER GARDEN, FL 34787-6099
- **Practice address phone:** (321) 663-8247
- **Mailing address:** 1230 W POINTE VILLAS BLVD BLDG APT 203, WINTER GARDEN, FL 34787-6099
- **Mailing address phone:** (321) 663-8247

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 322032 | FL | Yes |

## Other

- **Enumeration date:** 04/27/2016
- **Last updated:** 04/27/2016