Provider Demographics
NPI:1255600581
Name:JOHNSON, THERESA CARLA NEGRIDO (NP-C)
Entity type:Individual
Prefix:
First Name:THERESA CARLA
Middle Name:NEGRIDO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:THERESA CARLA
Other - Middle Name:BELARMINO
Other - Last Name:NEGRIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:71 BLANCA DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3729
Mailing Address - Country:US
Mailing Address - Phone:818-445-5414
Mailing Address - Fax:
Practice Address - Street 1:400 PARNASSUS AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2202
Practice Address - Country:US
Practice Address - Phone:415-353-2161
Practice Address - Fax:415-353-2505
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL685968163WN0800X
CA3636364SC0200X
CA95004522363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience
No364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily