Provider Demographics
NPI:1831613926
Name:JOHNSON, TONYA LYNETTE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:LYNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:AL
Mailing Address - Zip Code:35127-1669
Mailing Address - Country:US
Mailing Address - Phone:205-305-7273
Mailing Address - Fax:
Practice Address - Street 1:5243 OLD SPRINGVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-3674
Practice Address - Country:US
Practice Address - Phone:205-228-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-090844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily