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NPI Code Detail

MEDICARE: ALANA JOHNSON

MEDICARE:   ALANA  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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1962873133
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALANA JOHNSON
Provider Business Mailing Address
First Line : 111 LAKE HOLLINGSWORTH DR
Second Line : BOX 4980
City : LAKELAND
State : FL
Zip : 33801-5607
Country : US
Telephone Number : 239-595-9118
Fax Number :
Provider Business Practice Location Address
First Line : 111 LAKE HOLLINGSWORTH DR
Second Line : BOX 4980
City : LAKELAND
State : FL
Zip : 33801-5607
Country : US
Telephone Number : 239-595-9118
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2015
Last Update Date : 10/14/2015

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