Healthcare Provider Details

I. General information

NPI: 1881408656
Provider Name (Legal Business Name): TINA HA-JOHNSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 07/22/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MERCY MEDICAL CENTER 345 ST PAUL PL
BALTIMORE MD
21202
US

IV. Provider business mailing address

234 ANGELICA WAY
NEW FREEDOM PA
17349-8911
US

V. Phone/Fax

Practice location:
  • Phone: 443-306-9942
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR225672
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR225672
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: