MEDICARE: MISS TABATHA C JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	AP130052	TX

General Provider Information

NPI Number	:	1043677222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TABATHA C JOHNSON

Provider Business Mailing Address
First Line	:	1730 B F TERRY BLVD STE 302
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-5535
Country	:	US
Telephone Number	:	832-272-0201
Fax Number	:	281-633-2298

Provider Business Practice Location Address
First Line	:	1730 B F TERRY BLVD STE 302
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-5535
Country	:	US
Telephone Number	:	281-633-0148
Fax Number	:	281-633-2298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	07/17/2025

Similar Medicare Providers

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Practice Location Address:

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1962352435 — EXTRAORDINARY PEOPLE L.L.C.
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Practice Location Address:

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1881681542 — DR. FARIS G. OHAN O. D.
Practice Location Address:

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Directions to “ MISS TABATHA C JOHNSON ” Practice Location

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