Provider Demographics
NPI:1134594989
Name:JOHNSON, CAROLINA (NURSE)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:DEL CARMEN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-5571
Mailing Address - Fax:912-435-6232
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-435-5571
Practice Address - Fax:912-435-6232
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN064400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse