Healthcare Provider Details

I. General information

NPI: 1376534537
Provider Name (Legal Business Name): VALERIE V JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: VALERIE VICTORIA TIGNO M.D.

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BAYSHORE BLVD MACDILL AFB
TAMPA FL
33621-1607
US

IV. Provider business mailing address

3638 FLORIDA RANCH BLVD
ZEPHYRHILLS FL
33541-4522
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9805
  • Fax:
Mailing address:
  • Phone: 813-827-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA60496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: