Healthcare Provider Details

I. General information

NPI: 1427984186
Provider Name (Legal Business Name): DESHEKA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 N PALO ALTO AVE APT 235
PANAMA CITY FL
32401-5832
US

IV. Provider business mailing address

1450 N PALO ALTO AVE APT 235
PANAMA CITY FL
32401-5832
US

V. Phone/Fax

Practice location:
  • Phone: 229-854-0193
  • Fax:
Mailing address:
  • Phone: 229-854-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number130738200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: