Healthcare Provider Details

I. General information

NPI: 1740575521
Provider Name (Legal Business Name): CAROL MANIACI JOHNSON AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E ALTAMONTE DR SUITE 200
ALTAMONTE SPRINGS FL
32701-4806
US

IV. Provider business mailing address

711 E ALTAMONTE DR SUITE 200
ALTAMONTE SPRINGS FL
32701-4806
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5466
  • Fax: 407-303-5467
Mailing address:
  • Phone: 407-303-5466
  • Fax: 407-303-5467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: