Provider Demographics
NPI:1679749261
Name:JOHNSON, CYNTHIA ELAINE
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-8679
Mailing Address - Country:US
Mailing Address - Phone:352-680-0909
Mailing Address - Fax:352-680-0909
Practice Address - Street 1:174 WILLOW RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-8679
Practice Address - Country:US
Practice Address - Phone:352-680-0909
Practice Address - Fax:352-680-0909
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor