Individual
JOHANNIE GARCIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
910 S. WINTERHAWK DR. # 107, ST AUGUSTINE, FL 32086-3858
(904) 826-7886
Mailing address
367 GIANNA WAY, ST AUGUSTINE, FL 32086
(904) 826-7886
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12653
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003576500
—
FL
Enumeration date
03/14/2011
Last updated
09/19/2012
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