Provider Demographics
NPI:1720387616
Name:JOHNSON, MELISSA CA (CD(DONA), HBCE)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CD(DONA), HBCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 MYRA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3604
Mailing Address - Country:US
Mailing Address - Phone:904-483-1717
Mailing Address - Fax:
Practice Address - Street 1:2344 MYRA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3604
Practice Address - Country:US
Practice Address - Phone:904-483-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator