MEDICARE: ELIZABETH JOHNSON APRN-CNP, ACNP-AG

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	363LA2100X	Acute Care Nurse Practitioner	1212436	TX

General Provider Information

NPI Number	:	1821969411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JOHNSON APRN-CNP, ACNP-AG

Provider Business Mailing Address
First Line	:	2545 FAIRCHILD ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-1033
Country	:	US
Telephone Number	:	319-431-9539
Fax Number	:

Provider Business Practice Location Address
First Line	:	2545 FAIRCHILD ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-1033
Country	:	US
Telephone Number	:	319-431-9539
Fax Number	:

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

Provider Enumeration Date	:	09/16/2025
Last Update Date	:	09/17/2025

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