Provider Demographics
NPI:1962697466
Name:SANDRA JOHNSON-HILL
Entity type:Organization
Organization Name:SANDRA JOHNSON-HILL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOHNSON-HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:941-441-6395
Mailing Address - Street 1:286 MOUNT VERNON DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-4017
Mailing Address - Country:US
Mailing Address - Phone:941-441-6395
Mailing Address - Fax:
Practice Address - Street 1:286 MOUNT VERNON DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-4017
Practice Address - Country:US
Practice Address - Phone:941-441-6395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-09
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM19126261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center