Provider Demographics
NPI:1528567344
Name:JOHNSON, TANIA MICHELE (FNP)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:MICHELE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004 CANALETTO AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-7651
Mailing Address - Country:US
Mailing Address - Phone:661-364-8050
Mailing Address - Fax:
Practice Address - Street 1:500 OLD RIVER RD STE 110
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9509
Practice Address - Country:US
Practice Address - Phone:661-370-0777
Practice Address - Fax:661-654-8366
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily