Healthcare Provider Details

I. General information

NPI: 1891642294
Provider Name (Legal Business Name): ACHISA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 CABERNET PL
SAINT AUGUSTINE FL
32084-2577
US

IV. Provider business mailing address

461 CABERNET PL
SAINT AUGUSTINE FL
32084-2577
US

V. Phone/Fax

Practice location:
  • Phone: 904-677-0607
  • Fax:
Mailing address:
  • Phone: 904-677-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: