Individual
OCTAVIA SAMTESHIA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
919 S 25TH ST APT 2-102, FORT PIERCE, FL 34947-4602
(772) 801-7771
Mailing address
919 S 25TH ST APT 2-102, FORT PIERCE, FL 34947-4602
(772) 801-7771
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
3747A0650X
Attendant Care Provider
—
—
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
09/05/2022
Last updated
01/02/2023
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