Provider Demographics
NPI:1043445067
Name:JOHNSON, BRITTANY MARIA (MS ITDS)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MARIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 1/4 8TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2519
Mailing Address - Country:US
Mailing Address - Phone:850-418-1504
Mailing Address - Fax:
Practice Address - Street 1:33279 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:RIDGE MANOR
Practice Address - State:FL
Practice Address - Zip Code:33523-9041
Practice Address - Country:US
Practice Address - Phone:352-346-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist