Provider Demographics
NPI:1154687192
Name:JOHNSON-LARGENT, TIFFANY NICOLE (PHD, RD, LN, LD)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:NICOLE
Last Name:JOHNSON-LARGENT
Suffix:
Gender:F
Credentials:PHD, RD, LN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 K ST NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1602
Mailing Address - Country:US
Mailing Address - Phone:202-445-9743
Mailing Address - Fax:202-388-7830
Practice Address - Street 1:1629 K STREET, NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:202-445-9743
Practice Address - Fax:202-388-7830
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNU100000121133N00000X
MDDX3350133N00000X, 133V00000X
DCDI00000518133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered