Individual
LAVAROUS ANTWON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
401 W KENNEDY BLVD, TAMPA, FL 33606-1450
(757) 528-7563
Mailing address
302 W FLETCHER AVE, TAMPA, FL 33612-3415
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
12/22/2021
Last updated
05/25/2023
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