Provider Demographics
NPI:1376334375
Name:JOHNSTON, JADALYN
Entity type:Individual
Prefix:
First Name:JADALYN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADA
Other - Middle Name:
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JADALYN DEANDRADE
Mailing Address - Street 1:311 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-1851
Mailing Address - Country:US
Mailing Address - Phone:617-721-8778
Mailing Address - Fax:
Practice Address - Street 1:311 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-1851
Practice Address - Country:US
Practice Address - Phone:617-721-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula