Healthcare Provider Details

I. General information

NPI: 1922505569
Provider Name (Legal Business Name): TIKA JOHNSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 WEDGEWOOD AVE
NASHVILLE TN
37203-5440
US

IV. Provider business mailing address

1020 THRASHER DR
CLARKSVILLE TN
37040-1450
US

V. Phone/Fax

Practice location:
  • Phone: 615-709-2636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number210855
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24687
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: