Healthcare Provider Details

I. General information

NPI: 1285145342
Provider Name (Legal Business Name): TIFFANY S JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 CLEVELAND AVE STE 1964
COLUMBUS OH
43224-3677
US

IV. Provider business mailing address

570 N STATE ST STE 220
WESTERVILLE OH
43082-8217
US

V. Phone/Fax

Practice location:
  • Phone: 614-523-2929
  • Fax: 614-523-3388
Mailing address:
  • Phone: 380-207-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.022545
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.022545
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: