Provider Demographics
NPI:1619718491
Name:SMITH, JOHNIEKA
Entity type:Individual
Prefix:
First Name:JOHNIEKA
Middle Name:
Last Name:SMITH
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 1:5840 SUNDOWN CIR APT 327
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-9464
Mailing Address - Country:US
Mailing Address - Phone:407-252-4277
Mailing Address - Fax:
Practice Address - Street 1:5840 SUNDOWN CIR APT 327
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-9464
Practice Address - Country:US
Practice Address - Phone:407-252-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator