Individual
MRS. MELISSA A JOHNSON BOUCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1245 ARDMORE ST, SAINT AUGUSTINE, FL 32092-3441
(631) 374-9793
Mailing address
1245 ARDMORE ST, SAINT AUGUSTINE, FL 32092-3441
(631) 374-9793
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
FL
Other
Enumeration date
02/06/2023
Last updated
02/06/2023
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