Provider Demographics
NPI:1689269144
Name:LOCKWOOD, JAVONN MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JAVONN
Middle Name:MARIE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3118
Mailing Address - Country:US
Mailing Address - Phone:954-801-3430
Mailing Address - Fax:
Practice Address - Street 1:5200 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-3118
Practice Address - Country:US
Practice Address - Phone:954-801-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9297357163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse