Individual
MRS. MARIE GORETTI JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
235 TRUMPCO DR, ST AUGUSTINE, FL 32092-1879
(904) 881-5107
Mailing address
235 TRUMPCO DR, ST AUGUSTINE, FL 32092-1879
(904) 881-5107
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
9442872
FL
Other
Enumeration date
01/22/2019
Last updated
01/22/2019
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