Provider Demographics
NPI:1750078580
Name:JOHNSON, TARON XAVIER
Entity type:Individual
Prefix:
First Name:TARON
Middle Name:XAVIER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 MONTWARD PRESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4763
Mailing Address - Country:US
Mailing Address - Phone:904-551-8682
Mailing Address - Fax:
Practice Address - Street 1:8011 PHILIPS HWY STE 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7459
Practice Address - Country:US
Practice Address - Phone:904-928-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician