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General NPI Number Information
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NPI Number | 1851496046
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Entity Type | Individual
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Provider Name | TINA M JOHNSON FNP
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Gender | Female
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 1 COURT SQ WK STN 20-089
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City | LONG ISLAND CITY
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State | NY
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Zip | 11120-0001
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Country | US
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Telephone | 347-957-1252
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Fax | 347-396-4360
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Provider Business Mailing Address
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Address Line | 1 COURT SQ WK STN 20-089
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City | LONG ISLAND CITY
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State | NY
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Zip | 11120-0001
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Country | US
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Telephone | 347-957-1252
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Fax | 347-396-4360
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F334061
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License Number State | NY
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