Healthcare Provider Details

I. General information

NPI: 1023554722
Provider Name (Legal Business Name): NATASHA LEE ANN JOHNSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 FLOYD CURL DR SUITE 100
SAN ANTONIO TX
78229-3925
US

IV. Provider business mailing address

7930 FLOYD CURL DR SUITE 100
SAN ANTONIO TX
78229-3925
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-5520
  • Fax: 210-297-0632
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number800396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: