Provider Demographics
NPI:1932140951
Name:JIRIKOVEC, JOHANNA (NP)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:
Last Name:JIRIKOVEC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JOHANNA
Other - Middle Name:EVELYN
Other - Last Name:COPELAND-JIRIKOVEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2548 RIDEOUT LN
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-7686
Mailing Address - Country:US
Mailing Address - Phone:615-410-4990
Mailing Address - Fax:615-410-4250
Practice Address - Street 1:2548 RIDEOUT LN
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128
Practice Address - Country:US
Practice Address - Phone:615-410-4990
Practice Address - Fax:615-410-4250
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner