Healthcare Provider Details

I. General information

NPI: 1225840887
Provider Name (Legal Business Name): ACOYA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 W WARREN AVE
LONGWOOD FL
32750-4004
US

IV. Provider business mailing address

7851 DAVIE ROAD EXT APT 1107
HOLLYWOOD FL
33024-2548
US

V. Phone/Fax

Practice location:
  • Phone: 800-614-4124
  • Fax:
Mailing address:
  • Phone: 754-465-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW20491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: