Provider Demographics
NPI:1942772033
Name:JOHNSON, TERESA ANN I
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:JOHNSON
Suffix:I
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 1:3103 CURTIS AVE S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-4140
Mailing Address - Country:US
Mailing Address - Phone:239-822-7645
Mailing Address - Fax:239-369-7238
Practice Address - Street 1:3103 CURTIS AVE S
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-4140
Practice Address - Country:US
Practice Address - Phone:239-822-7645
Practice Address - Fax:239-369-7238
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-30
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant