Healthcare Provider Details

I. General information

NPI: 1285111260
Provider Name (Legal Business Name): SHIRLINE BEVERLY JOHNSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SLEEPY HOLLOW DR
MIDDLETOWN DE
19709-5838
US

IV. Provider business mailing address

206 APPLE TREE LN
MIDDLETOWN DE
19709-9393
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-3030
  • Fax: 302-449-3040
Mailing address:
  • Phone: 302-310-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0001113
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0001113
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: