Johnson, Tara Demetria
Johnson, Tara Demetria is an sole proprietor health care provider with primary practice located at 226 Abalone Rd Nw , Palm Bay FL 32907-2964. She recently has only one registered license in Nursing & Custodial Care Facilities / Assisted Living Facility, which is considered as her primary health care specialty. Johnson, Tara Demetria can be contacted via phone (321) 480-4052.Contact Information
Primary practice address
226 Abalone Rd Nw
Palm Bay FL 32907-2964
Phone: (321) 480-4052
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing & Custodial Care Facilities / Assisted Living Facility | 310400000X | ALF13181 | Florida |
Profile Details
| NPI number | 1851883706 |
|---|---|
| LBN Legal business name | Johnson, Tara Demetria |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 5th, 2018 |
| Last updated | Jun 5th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1851883706 | NPPES |
| Florida | MEDICAID | FL |
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