Provider Demographics
NPI:1679227169
Name:JOHNSON, CATHY SPENCER (LPN)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:SPENCER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-1501
Mailing Address - Country:US
Mailing Address - Phone:850-509-2847
Mailing Address - Fax:
Practice Address - Street 1:519 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-1501
Practice Address - Country:US
Practice Address - Phone:850-509-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3104A0625X, 374U00000X, 376J00000X, 251E00000X
FL5177811164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No251E00000XAgenciesHome Health