Healthcare Provider Details

I. General information

NPI: 1740019041
Provider Name (Legal Business Name): QUINTELL JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FOWLER GROVE BLVD STE 220
WINTER GARDEN FL
34787-5597
US

IV. Provider business mailing address

2200 FOWLER GROVE BLVD STE 220
WINTER GARDEN FL
34787-5597
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-0042
  • Fax:
Mailing address:
  • Phone: 407-656-0042
  • Fax: 407-565-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN40303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: