Provider Demographics
NPI:1467121582
Name:JOHNSON, TIFFANY N (CNA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ELIM LN
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-2013
Mailing Address - Country:US
Mailing Address - Phone:803-522-3786
Mailing Address - Fax:
Practice Address - Street 1:106 ELIM LN
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2013
Practice Address - Country:US
Practice Address - Phone:803-522-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC564629376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide