Healthcare Provider Details

I. General information

NPI: 1881866978
Provider Name (Legal Business Name): KELVIN LUCAIN JOHNSON LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 HYACINTH AVE #B
TAMPA FL
33612
US

IV. Provider business mailing address

PO BOX 8431
TAMPA FL
33674
US

V. Phone/Fax

Practice location:
  • Phone: 941-301-5578
  • Fax:
Mailing address:
  • Phone: 941-301-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5149342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: