Provider Demographics
NPI:1649947888
Name:GARCIA, JOHNNA BETH (NP)
Entity type:Individual
Prefix:MRS
First Name:JOHNNA
Middle Name:BETH
Last Name:GARCIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 DOLPHIN PL
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1512
Mailing Address - Country:US
Mailing Address - Phone:254-718-9353
Mailing Address - Fax:
Practice Address - Street 1:302 DOLPHIN PL
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1512
Practice Address - Country:US
Practice Address - Phone:254-718-9353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX816738163WN0002X
TX1047122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care