| NPI | 1952775124 |
|---|---|
| Former Name | JACQUELYN JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN3334082) |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2024-07-08 |