MEDICARE: NICOLE JOHNSON FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP10079	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568903490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE JOHNSON FNP-BC

Provider Business Mailing Address
First Line	:	261 N ROOSEVELT AVE
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2617
Country	:	US
Telephone Number	:	480-677-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 S 83RD AVE STE 113
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-7206
Country	:	US
Telephone Number	:	480-677-8282
Fax Number	:	480-535-0962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	08/22/2024

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Directions to “ NICOLE JOHNSON FNP-BC” Practice Location

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