Provider Demographics
NPI:1760213649
Name:JOHNSON, TIMOTHY ALAN
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2728
Mailing Address - Country:US
Mailing Address - Phone:352-431-5514
Mailing Address - Fax:
Practice Address - Street 1:2036 S TANNER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32820-1031
Practice Address - Country:US
Practice Address - Phone:352-431-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion