Provider Demographics
NPI:1629415500
Name:JOHNSON, TANYA MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 SE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-9309
Mailing Address - Country:US
Mailing Address - Phone:352-572-0428
Mailing Address - Fax:352-622-4948
Practice Address - Street 1:3306 SW 26TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7856
Practice Address - Country:US
Practice Address - Phone:352-622-2020
Practice Address - Fax:352-622-2025
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9213321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily