Provider Demographics
NPI:1114797933
Name:JOHNSON, JAHNIQUE SACKIYA (WHNP)
Entity Type:Individual
Prefix:MS
First Name:JAHNIQUE
Middle Name:SACKIYA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:MS
Other - First Name:JAHNIQUE
Other - Middle Name:SACKIYA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:WHNP
Mailing Address - Street 1:828 E 215TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5813
Mailing Address - Country:US
Mailing Address - Phone:332-209-9226
Mailing Address - Fax:
Practice Address - Street 1:828 E 215TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5813
Practice Address - Country:US
Practice Address - Phone:332-209-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF421693363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health