Provider Demographics
NPI:1437920055
Name:JOHNSON, PRECIOUS
Entity Type:Individual
Prefix:PROF
First Name:PRECIOUS
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 1:2618 TANOAK TER
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-3831
Mailing Address - Country:US
Mailing Address - Phone:863-521-7863
Mailing Address - Fax:
Practice Address - Street 1:2618 TANOAK TER
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-3831
Practice Address - Country:US
Practice Address - Phone:863-521-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X, 372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251E00000XAgenciesHome Health
No372600000XNursing Service Related ProvidersAdult Companion