Provider Demographics
NPI:1457658171
Name:JOHNSON, JARNICE LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:JARNICE
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11919 HESPERIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-2158
Mailing Address - Country:US
Mailing Address - Phone:760-948-1454
Mailing Address - Fax:760-948-6100
Practice Address - Street 1:11919 HESPERIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-2158
Practice Address - Country:US
Practice Address - Phone:760-948-1454
Practice Address - Fax:760-948-6100
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21342363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical