Provider Demographics
NPI:1164610440
Name:JOHNSON, ALETA
Entity Type:Individual
Prefix:
First Name:ALETA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 TEMPLEMORE DR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-6829
Mailing Address - Country:US
Mailing Address - Phone:850-937-0343
Mailing Address - Fax:850-937-0343
Practice Address - Street 1:1423 TEMPLEMORE DR
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-6829
Practice Address - Country:US
Practice Address - Phone:850-937-0343
Practice Address - Fax:850-937-0343
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker