Individual
MR. JAQUEZ TERELL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MBA
Contact information
Practice address
113 DINNER LAKE AVE, LAKE WALES, FL 33859-2155
(662) 769-4077
Mailing address
113 DINNER LAKE AVE, LAKE WALES, FL 33859-2155
(662) 769-4077
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/05/2024
Last updated
06/05/2024
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