Healthcare Provider Details

I. General information

NPI: 1538055801
Provider Name (Legal Business Name): EMILY ELAINE JOHNSON RN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 VALLEY CENTRE DR
SAN DIEGO CA
92130-2332
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-7272
  • Fax: 858-764-3063
Mailing address:
  • Phone: 858-554-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95038497
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: