Healthcare Provider Details

I. General information

NPI: 1124233473
Provider Name (Legal Business Name): THERESA M JOHNSON RN BC APRN LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 PARK RD 3RD FL
WEST HURTFORD CT
06119
US

IV. Provider business mailing address

9A FARMINGTON CHASE CRESCENT
FARMINGTON CT
06032-3132
US

V. Phone/Fax

Practice location:
  • Phone: 860-523-1101
  • Fax:
Mailing address:
  • Phone: 860-677-0367
  • Fax: 860-677-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLADC000161
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRNE33028
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN002487
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: