Healthcare Provider Details

I. General information

NPI: 1477939551
Provider Name (Legal Business Name): TANYA JEANNE JOHNSON-GILCHRIST LCSW, MSW, MPH, CPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 VINE CLIFF ST
RUSKIN FL
33570-4935
US

IV. Provider business mailing address

PO BOX 6823
TAMPA FL
33608-0823
US

V. Phone/Fax

Practice location:
  • Phone: 813-609-2655
  • Fax: 813-381-3909
Mailing address:
  • Phone: 813-609-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 12868
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number9457
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: