Individual
JEANETTE DELORIS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29 ROYAL LEAF LN, PALM COAST, FL 32164-6998
(386) 313-1609
Mailing address
29 ROYAL LEAF LN, PALM COAST, FL 32164-6998
(386) 852-7628
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230362100
—
FL
Enumeration date
05/19/2008
Last updated
02/27/2019
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