Organization
TJ WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAISHA JOHNSON APRN (NURSE PRACTITIONER)
(772) 643-1645
Entity
Organization
Contact information
Practice address
1893 SW KIMBERLY AVE, PORT ST LUCIE, FL 34953-1020
(772) 643-1645
Mailing address
1893 SW KIMBERLY AVE, PORT ST LUCIE, FL 34953-1020
(772) 643-1645
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/14/2019
Last updated
06/02/2022
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