Provider Demographics
NPI:1235389107
Name:JOHNSON, TIFFANY L (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 WOODLAWN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504
Mailing Address - Country:US
Mailing Address - Phone:713-946-6081
Mailing Address - Fax:
Practice Address - Street 1:4102 WOODLAWN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1947
Practice Address - Country:US
Practice Address - Phone:713-946-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX676193363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care