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General NPI Number Information
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NPI Number | 1093666950
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Entity Type | Individual
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Provider Name | RENEE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 02/06/2026
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 550 BALMORAL CIR N STE 305
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City | JACKSONVILLE
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State | FL
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Zip | 32218-5583
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Country | US
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Telephone | 561-951-0914
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Fax |
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Provider Business Mailing Address
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Address Line | 637 WILDLIGHT AVE APT 419
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City | YULEE
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State | FL
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Zip | 32097-0203
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Country | US
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Telephone | 619-755-7980
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA107778
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License Number State | FL
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