Healthcare Provider Details

I. General information

NPI: 1841675576
Provider Name (Legal Business Name): TIA LEIGH JOHNSON APRN, APRN-CNP, FNP,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIA JOHNSON

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N 1200 W
OREM UT
84057-2449
US

IV. Provider business mailing address

1433 N 1200 W
OREM UT
84057-2449
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5450
  • Fax: 385-225-9327
Mailing address:
  • Phone: 801-655-5450
  • Fax: 385-225-9327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11663939-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number76975
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: