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General NPI Number Information
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NPI Number | 1629209515
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Entity Type | Individual
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Provider Name | MS. LATIVIA DEANNA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 07/27/2009
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Provider Practice Location Address
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Address Line | 1306 E ANNIE ST APT A
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City | TAMPA
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State | FL
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Zip | 33612-8746
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Country | US
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Telephone | 863-440-2662
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Fax | 813-982-2039
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Provider Business Mailing Address
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Address Line | PO BOX 1003
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City | FORT MEADE
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State | FL
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Zip | 33841-1003
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Country | US
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Telephone | 863-440-2662
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Fax | 813-982-2039
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 230667
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License Number State | FL
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