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General NPI Number Information
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NPI Number | 1154687192
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Entity Type | Individual
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Provider Name | TIFFANY NICOLE JOHNSON-LARGENT PH.D., RD, LN, LD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 1629 K STREET, NW SUITE 300
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City | WASHINGTON
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State | DC
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Zip | 20006
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Country | US
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Telephone | 202-445-9743
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Fax | 202-388-7830
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Provider Business Mailing Address
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Address Line | 1629 K ST NW SUITE 300
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City | WASHINGTON
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State | DC
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Zip | 20006-1602
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Country | US
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Telephone | 202-445-9743
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Fax | 202-388-7830
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | NU100000121
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DX3350
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DI00000518
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DX3350
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License Number State | MD
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