Individual
JEFFERY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10905 N 14TH ST, TAMPA, FL 33612-5921
(813) 404-3044
(813) 754-1659
Mailing address
1225 ALPINE LAKE DR, BRANDON, FL 33511-1898
(813) 404-3044
(813) 754-1659
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
6200-SC
FL
Other
Enumeration date
03/26/2026
Last updated
03/26/2026
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