Healthcare Provider Details

I. General information

NPI: 1720387616
Provider Name (Legal Business Name): MELISSA CA JOHNSON CD(DONA), HBCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2344 MYRA ST
JACKSONVILLE FL
32204-3604
US

IV. Provider business mailing address

2344 MYRA ST
JACKSONVILLE FL
32204-3604
US

V. Phone/Fax

Practice location:
  • Phone: 904-483-1717
  • Fax:
Mailing address:
  • Phone: 904-483-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: