Provider Demographics
NPI:1083693444
Name:JOHNSTON, MARIA E (FNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-746-5001
Mailing Address - Fax:520-573-9607
Practice Address - Street 1:3939 S PARK AVE
Practice Address - Street 2:#150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1635
Practice Address - Country:US
Practice Address - Phone:520-746-5001
Practice Address - Fax:520-573-9607
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN048006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ364414Medicaid
AZ103679Medicare PIN
S27610Medicare UPIN