Healthcare Provider Details

I. General information

NPI: 1619883501
Provider Name (Legal Business Name): WANICA LASHAE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICKY JOHNSON

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 FRANKLIN ST
ALTAMONTE SPRINGS FL
32701-7520
US

IV. Provider business mailing address

922 FRANKLIN ST
ALTAMONTE SPRINGS FL
32701-7520
US

V. Phone/Fax

Practice location:
  • Phone: 407-757-4813
  • Fax:
Mailing address:
  • Phone: 407-757-4813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License NumberJ302174180000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: