Provider Demographics
NPI:1073958070
Name:JOHNSON, TINA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:PINEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3960 N STUDEBAKER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2458
Mailing Address - Country:US
Mailing Address - Phone:562-982-4208
Mailing Address - Fax:562-286-8344
Practice Address - Street 1:3960 N STUDEBAKER RD STE 102
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2458
Practice Address - Country:US
Practice Address - Phone:562-982-4208
Practice Address - Fax:562-286-8344
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA483629OtherREGISTERED NURSE
CA22927OtherFURNISHING
CA22927OtherNURSE PRACTITIONER
CA483629OtherREGISTERED NURSE