Provider Demographics
NPI:1295029411
Name:JOHNSON, GINA (ARNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CADILLAC DR
Mailing Address - Street 2:STE 350
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5078
Mailing Address - Country:US
Mailing Address - Phone:615-523-5656
Mailing Address - Fax:615-523-5657
Practice Address - Street 1:10 CADILLAC DR
Practice Address - Street 2:STE 350
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5078
Practice Address - Country:US
Practice Address - Phone:615-523-5656
Practice Address - Fax:615-523-5657
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9267595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily