Healthcare Provider Details

I. General information

NPI: 1134011653
Provider Name (Legal Business Name): TANEKA JOHNSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 CORPORATE DR W
LANGHORNE PA
19047-8011
US

IV. Provider business mailing address

600 N BROAD ST STE 5 #3180
MIDDLETOWN DE
19709
US

V. Phone/Fax

Practice location:
  • Phone: 484-202-0751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010869
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP036375
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: