=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912366279
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA MARIE JOHANSEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2016
-----------------------------------------------------
Last Update Date | 02/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10050 W BELL RD STE 35
-----------------------------------------------------
City | SUN CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85351-1290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-281-1130
-----------------------------------------------------
Fax | 623-281-1132
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 WOODMONT BLVD STE 600
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37205-5250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-314-5257
-----------------------------------------------------
Fax | 615-692-0547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0000487
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------