Provider Demographics
NPI:1477227825
Name:JOHNSON, JADE SABINA
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:SABINA
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 1:222 N HIAWASSEE RD APT 97
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1077
Mailing Address - Country:US
Mailing Address - Phone:321-444-7176
Mailing Address - Fax:
Practice Address - Street 1:222 N HIAWASSEE RD APT 97
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1077
Practice Address - Country:US
Practice Address - Phone:321-444-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty