Individual
DEREKIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8278 GOLDEN BAMBOO DR, JACKSONVILLE, FL 32219-6012
(904) 616-8677
Mailing address
8278 GOLDEN BAMBOO DR, JACKSONVILLE, FL 32219-6012
(904) 616-8677
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5214949
FL
3140N1450X
Pediatric Skilled Nursing Facility
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Other
Enumeration date
06/08/2020
Last updated
06/08/2020
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