MEDICARE: ANNESHA JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508340191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNESHA JOHNSON

Provider Business Mailing Address
First Line	:	2014 MIDYETTE RD APT 205
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-6255
Country	:	US
Telephone Number	:	786-566-1707
Fax Number	:

Provider Business Practice Location Address
First Line	:	2940 E PARK AVE
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-3446
Country	:	US
Telephone Number	:	850-643-1033
Fax Number	:	850-643-5066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	08/09/2021

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Directions to “ ANNESHA JOHNSON ” Practice Location

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