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General NPI Number Information
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NPI Number | 1528734548
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Entity Type | Individual
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Provider Name | MRS. SHANTANA D JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 1920 VERANO DR STE 105
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City | HAINES CITY
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State | FL
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Zip | 33844-8585
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Country | US
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Telephone | 321-217-2409
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Fax | 855-257-1340
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Provider Business Mailing Address
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Address Line | 1190 BLARNEY ST
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City | MINNEOLA
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State | FL
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Zip | 34715-7634
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Country | US
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Telephone | 321-217-2409
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Fax | 855-257-1340
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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 | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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Taxonomy #4
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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Taxonomy #5
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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Taxonomy #6
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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Taxonomy #7
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Taxonomy Code | 385HR2050X
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Taxonomy Name | Respite Care Camp
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Taxonomy #8
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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Taxonomy #9
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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Taxonomy #10
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299995365
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License Number State | FL
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