Individual
JENELL NICOLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6118 NW DUKE CIR, PORT ST LUCIE, FL 34983-3336
(954) 589-4520
Mailing address
7745 EMBASSY BLVD, MIRAMAR, FL 33023-6407
(954) 589-4520
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
171245099
FL
Other
Enumeration date
06/15/2024
Last updated
06/15/2024
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