Tara Demetria Johnson

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ALF13181 Issued in FL

Practice address

226 Abalone Rd NW
Palm Bay, FL 32907-2964

Phone

(321) 480-4052

NPI assigned

Jun 5, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rome'S Paradise Assisted Living LLC

  • Assisted Living Facility
  • Palm Bay, FL
  • NPI 1679055602
  NPD Authorized official
• Step Group Home

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Palm Bay, FL
  • NPI 1598610578
  NPD (past) Authorized official
• Rome'S Paradise Assisted Living II

  • Assisted Living Facility
  • Palm Bay, FL
  • NPI 1003423294
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528156800000",
    "number": "1851883706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 HANFORD RD SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329081200",
            "telephone_number": "321-480-4052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 ABALONE RD NW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329072964",
            "telephone_number": "321-480-4052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TARA",
        "middle_name": "DEMETRIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-05",
        "last_updated": "2018-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "ALF13181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FL",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gloria Rae Johnson, NURSE PRACTITIONER
• Nicole Johnson
• Rebecca L Johnson
• Ruth Annette Johnson
• Samanthia Johnson, LPN
• Timothy Cameron Johnson Jr., PHARMD
• Coleen Basta Johnston, D.V.M.
• Audrey C Joiner, ARNP
• Akasia L Jones
• Amedia Renay Jones, CNA/OWNER

• Assisted Living Facility in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.