MEDICARE: TATIANNA 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	224P00000X	Prosthetist	BCB-2025-1416	NM

General Provider Information

NPI Number	:	1659235729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANNA JOHNSON

Provider Business Mailing Address
First Line	:	1751 BELLAMAH AVE NW APT 2109
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2226
Country	:	US
Telephone Number	:	512-522-9552
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 BELLAMAH AVE NW APT 2109
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-2226
Country	:	US
Telephone Number	:	512-522-9552
Fax Number	:

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/18/2025

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Directions to “ TATIANNA JOHNSON ” Practice Location

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