Provider Demographics
NPI:1891221081
Name:JOHNSON, AHMAAD (APRN)
Entity Type:Individual
Prefix:MR
First Name:AHMAAD
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 CHRISTIAN ST APT E
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2558
Mailing Address - Country:US
Mailing Address - Phone:814-360-4700
Mailing Address - Fax:
Practice Address - Street 1:2232 CHRISTIAN ST APT E
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-2558
Practice Address - Country:US
Practice Address - Phone:814-360-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-07
Last Update Date:2017-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily