Provider Demographics
NPI:1952289019
Name:JOHNSON, JENNIFER LATRICE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LATRICE
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 1:526 HOFFMAN AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-3517
Mailing Address - Country:US
Mailing Address - Phone:267-407-5125
Mailing Address - Fax:
Practice Address - Street 1:526 HOFFMAN AVE APT 3A
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3517
Practice Address - Country:US
Practice Address - Phone:267-407-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula