Provider Demographics
NPI:1104242668
Name:JOHNSON, JAZZMINA (APRN-RX)
Entity type:Individual
Prefix:MRS
First Name:JAZZMINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 KUULEI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2702
Mailing Address - Country:US
Mailing Address - Phone:808-286-0350
Mailing Address - Fax:
Practice Address - Street 1:315 KUULEI RD
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2702
Practice Address - Country:US
Practice Address - Phone:808-286-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI70011163W00000X
HI1857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse