Individual
AUDREY BOLLER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1718 BROOKSIDE BLVD, TALLAHASSEE, FL 32301-6770
(954) 294-5973
Mailing address
1718 BROOKSIDE BLVD, TALLAHASSEE, FL 32301-6770
(888) 835-0572
(850) 201-6734
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
172V00000X
Community Health Worker
—
—
174H00000X
Health Educator
—
—
183500000X
Pharmacist
Primary
PS25698
FL
Other
Enumeration date
12/23/2015
Last updated
07/25/2023
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