Provider Demographics
NPI:1609142629
Name:JOHNSON, TANNYE FLAKE (MED)
Entity Type:Individual
Prefix:MRS
First Name:TANNYE
Middle Name:FLAKE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2854
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-2854
Mailing Address - Country:US
Mailing Address - Phone:352-732-3333
Mailing Address - Fax:352-732-2469
Practice Address - Street 1:1515 E SILVER SPRINGS BLVD
Practice Address - Street 2:STE 112
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6831
Practice Address - Country:US
Practice Address - Phone:352-732-3333
Practice Address - Fax:352-732-2469
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10989101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health