Provider Demographics
NPI:1184308272
Name:JOHNSON, DANIELLE RENEE (CNA)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86078 CLYDE ST
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-3243
Mailing Address - Country:US
Mailing Address - Phone:904-624-3911
Mailing Address - Fax:
Practice Address - Street 1:86078 CLYDE ST
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-3243
Practice Address - Country:US
Practice Address - Phone:904-624-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA436411374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty