Provider Demographics
NPI:1831606334
Name:JOHNSON, TIFFANY ANN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21826 BARTON WOODS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2350
Mailing Address - Country:US
Mailing Address - Phone:210-846-2232
Mailing Address - Fax:
Practice Address - Street 1:12412 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3255
Practice Address - Country:US
Practice Address - Phone:210-757-7000
Practice Address - Fax:210-757-7000
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135157208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist