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General NPI Number Information
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NPI Number | 1619895083
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Entity Type | Individual
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Provider Name | TIJUANA MARIE JOHNSON FNP
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Gender | Female
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 711 N DEKALB ST
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City | SHELBY
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State | NC
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Zip | 28150-3911
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Country | US
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Telephone | 704-482-1482
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 BEVERLY AVE
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City | SHELBY
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State | NC
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Zip | 28152-6305
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Country | US
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Telephone | 704-477-4348
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5024837
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License Number State | NC
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