MEDICARE: MS. TIFFANY MONIQUE 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	163WC1500X	Community Health Registered Nurse	817918	NV
2	163WA2000X	Administrator Registered Nurse	817918	NV
3	163W00000X	Registered Nurse	817918	NV

General Provider Information

NPI Number	:	1952668444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIFFANY MONIQUE JOHNSON

Provider Business Mailing Address
First Line	:	8908 DISCOVERY REEF AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-2970
Country	:	US
Telephone Number	:	702-308-3012
Fax Number	:

Provider Business Practice Location Address
First Line	:	8908 DISCOVERY REEF AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-2970
Country	:	US
Telephone Number	:	702-308-3012
Fax Number	:

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

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	10/15/2025

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