Provider Demographics
NPI:1851912505
Name:JOHNSON, JOANNA
Entity Type:Individual
Prefix:MS
First Name:JOANNA
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 1:10910 KEYS GATE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4266
Mailing Address - Country:US
Mailing Address - Phone:813-210-1233
Mailing Address - Fax:
Practice Address - Street 1:10910 KEYS GATE DRIVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579
Practice Address - Country:US
Practice Address - Phone:813-215-6275
Practice Address - Fax:866-636-0443
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist