Healthcare Provider Details

I. General information

NPI: 1033492236
Provider Name (Legal Business Name): MICHELE JOHNSON-TOWSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 W FLETCHER AVE
TAMPA FL
33612-3366
US

IV. Provider business mailing address

1338 W FLETCHER AVE
TAMPA FL
33612-3366
US

V. Phone/Fax

Practice location:
  • Phone: 813-264-2288
  • Fax: 813-264-1677
Mailing address:
  • Phone: 813-264-2288
  • Fax: 813-264-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME62751
License Number StateFL

VIII. Authorized Official

Name: DR. MICHELE JOHNSON-TOWSON
Title or Position: OWNER
Credential: MD
Phone: 813-264-2288