Provider Demographics
NPI:1457031742
Name:JOHNSON, JACOB AARON (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:AARON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 WARKWORTH LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-1206
Mailing Address - Country:US
Mailing Address - Phone:903-932-1762
Mailing Address - Fax:
Practice Address - Street 1:3201 UNIVERSITY DR E STE 135
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3481
Practice Address - Country:US
Practice Address - Phone:979-703-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily