Provider Demographics
NPI:1467865394
Name:JOHNSON, TANJA ELANA (NP)
Entity Type:Individual
Prefix:MS
First Name:TANJA
Middle Name:ELANA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5843
Mailing Address - Country:US
Mailing Address - Phone:541-908-3672
Mailing Address - Fax:
Practice Address - Street 1:4450 ARAPAHOE AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-9102
Practice Address - Country:US
Practice Address - Phone:720-613-0677
Practice Address - Fax:800-878-1836
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0990711363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner