Individual
RAVEN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3264 SPLIT WILLOW DR, ORLANDO, FL 32808-3735
(321) 946-4900
Mailing address
3264 SPLIT WILLOW DR, ORLANDO, FL 32808-3735
(321) 946-4900
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
372600000X
Adult Companion
—
—
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
05/25/2022
Last updated
02/26/2024
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