Healthcare Provider Details

I. General information

NPI: 1407196447
Provider Name (Legal Business Name): SHARMILA S. JOHNSON AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S GOVERNORS AVE STE 101A
DOVER DE
19904-3530
US

IV. Provider business mailing address

640 S. STATE STREET MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-7980
  • Fax: 302-744-7989
Mailing address:
  • Phone: 302-744-7980
  • Fax: 302-744-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0000122
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberLP-0000122
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberLP-0000122
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberLP-0000122
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: