Provider Demographics
NPI:1669635447
Name:JOHNSON, AVA C (NP)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:JEAN
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4049 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHINCOTEAGUE
Mailing Address - State:VA
Mailing Address - Zip Code:23336-2406
Mailing Address - Country:US
Mailing Address - Phone:757-336-3682
Mailing Address - Fax:757-336-3703
Practice Address - Street 1:4049 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHINCOTEAGUE
Practice Address - State:VA
Practice Address - Zip Code:23336-2406
Practice Address - Country:US
Practice Address - Phone:757-336-3682
Practice Address - Fax:757-336-3703
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily