| Doctor Name: | MS. NICOLE JASMINE JOHNSON |
| NPI Number: | 1063422905 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, MA, LCSW |
| License Number: | SW9363 |
| Business Practice Address: | 10000 Bay Pines Blvd Bay Pines, FL - 337445005 |
| Business Phone Number: | 8134333562 |
| Business Fax Number: | |
| Mailing Address: | 101 South Old Coachman Rd., #115 CLEARWATER |
| State: | FL |
| Postal Code: | 33765 |
| Phone Number: | 8134333562 |
| Fax Number: | |
| NPI Enumeration Date: | 08/09/2006 |
| NPI Last Update Date: | 12/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | SW9363 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |