Provider Demographics
NPI:1932494259
Name:JOHNSON, BARBARA VAIATICA LUNA (MSN, ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:VAIATICA LUNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN, ANP-BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17 NEW MILL RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3323
Mailing Address - Country:US
Mailing Address - Phone:516-384-6597
Mailing Address - Fax:631-629-4772
Practice Address - Street 1:124 MAIN STREET
Practice Address - Street 2:SUITE 10
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6922
Practice Address - Country:US
Practice Address - Phone:631-629-4770
Practice Address - Fax:631-629-4772
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF305180-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health