Provider Demographics
NPI:1033636881
Name:JOHNSON, SUDINE SALOY (CNA)
Entity Type:Individual
Prefix:
First Name:SUDINE
Middle Name:SALOY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 W POINTE VILLAS BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6099
Mailing Address - Country:US
Mailing Address - Phone:321-663-8247
Mailing Address - Fax:
Practice Address - Street 1:1230 W POINTE VILLAS BLVD APT 203
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-6099
Practice Address - Country:US
Practice Address - Phone:321-663-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL322032376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$OtherSOCIAL SECURITY