Provider Demographics
NPI:1770364879
Name:JOHNSON, TYRASHA
Entity type:Individual
Prefix:
First Name:TYRASHA
Middle Name:
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 1:2412 AINGER PL SE APT 114
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3575
Mailing Address - Country:US
Mailing Address - Phone:202-390-0082
Mailing Address - Fax:
Practice Address - Street 1:2004 SAVANNAH ST SE APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7527
Practice Address - Country:US
Practice Address - Phone:202-422-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant