Provider Demographics
NPI:1467437384
Name:TORRES, JOHANNIE MARGARITA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNIE
Middle Name:MARGARITA
Last Name:TORRES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:JOHANNIE
Other - Middle Name:M
Other - Last Name:TRONCOSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7128 FULTON ST E
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8413
Practice Address - Country:US
Practice Address - Phone:616-825-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704200103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4395751Medicaid
MIOM98130015Medicare ID - Type Unspecified
MI4395751Medicaid