Individual
KATRINA M JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10225 MAGNOLIA RIDGE DR, JACKSONVILLE, FL 32210-4991
(904) 923-3505
Mailing address
10225 MAGNOLIA RIDGE DR, JACKSONVILLE, FL 32210-4991
(904) 923-3505
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100716400
—
FL
Enumeration date
03/06/2019
Last updated
03/06/2019
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