Provider Demographics
NPI:1720656879
Name:JOHNSON, TAMMY JEAN
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 MORNING VIEW RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2059
Mailing Address - Country:US
Mailing Address - Phone:512-777-9458
Mailing Address - Fax:
Practice Address - Street 1:1404 MORNING VIEW RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2059
Practice Address - Country:US
Practice Address - Phone:512-777-9458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334610164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse