Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ISW14412 | FL |
NPI | 1003404237 |
---|---|
Provider Name | Mrs. Alexan Taylor Johnson |
First Address | Seminole, FL 33772-5467 |
Second Address | Bay Pines, FL 33744-8200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2021 |
Last Update Date | 04/01/2021 |