Provider Demographics
NPI:1669723946
Name:JOHNSON, MORGAN ROSE (MED)
Entity type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:ROSE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5412
Mailing Address - Country:US
Mailing Address - Phone:904-910-1809
Mailing Address - Fax:
Practice Address - Street 1:202 W ELM ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5412
Practice Address - Country:US
Practice Address - Phone:904-910-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2448277Medicaid