Healthcare Provider Details

I. General information

NPI: 1346496767
Provider Name (Legal Business Name): TRISTIN MICHAEL JOHNSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 PEAR TREE LN SUITE 100
NAPA CA
94558-6484
US

IV. Provider business mailing address

1141 PEAR TREE LN SUITE 100
NAPA CA
94558-6484
US

V. Phone/Fax

Practice location:
  • Phone: 707-254-1770
  • Fax:
Mailing address:
  • Phone: 707-254-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number695830
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number73737
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number22192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: