Individual
MISS JAQUITSHA LA'KWONSHAY TYSON-JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2047 SW DANFORTH CIR, PALM CITY, FL 34990-7704
(772) 485-2242
Mailing address
390 NE 191ST ST # 8584, MIAMI, FL 33179-3899
(772) 485-2242
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
FL
Other
Enumeration date
09/25/2024
Last updated
11/09/2024
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