Healthcare Provider Details

I. General information

NPI: 1679825152
Provider Name (Legal Business Name): TONYA LEE JOHNSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ARIZONA ST
BISBEE AZ
85603-1804
US

IV. Provider business mailing address

155 CALLE PORTAL SUITE 100
SIERRA VISTA AZ
85635-2900
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-3309
  • Fax:
Mailing address:
  • Phone: 520-459-3012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8445
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: