Healthcare Provider Details

I. General information

NPI: 1639857725
Provider Name (Legal Business Name): NATASHIA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S ORANGE AVE
SOUTH ORANGE NJ
07079-2646
US

IV. Provider business mailing address

400 S ORANGE AVE
SOUTH ORANGE NJ
07079-2646
US

V. Phone/Fax

Practice location:
  • Phone: 973-761-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15483900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: