Individual
MRS. CLARENDA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9064 CASTLE BLVD, JACKSONVILLE, FL 32208-1602
(904) 651-4083
Mailing address
PO BOX 7164, JACKSONVILLE, FL 32238-0164
(904) 651-4083
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
—
—
376J00000X
Homemaker
Primary
233614
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
233614
AHCA STATE LICENSE
FL
Enumeration date
07/24/2014
Last updated
07/24/2014
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