Provider Demographics
NPI:1417573098
Name:JOHNSON, TAYESHA MARIE (APRN)
Entity Type:Individual
Prefix:MISS
First Name:TAYESHA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:TAYESHA
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:13944 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3804
Mailing Address - Country:US
Mailing Address - Phone:216-767-4242
Mailing Address - Fax:
Practice Address - Street 1:13944 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-3804
Practice Address - Country:US
Practice Address - Phone:216-767-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH026582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily