Provider Demographics
NPI:1104455419
Name:JOHNSON, NINA ALEXANDRA (PA)
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:ALEXANDRA
Last Name:JOHNSON
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3014
Mailing Address - Country:US
Mailing Address - Phone:914-772-1119
Mailing Address - Fax:
Practice Address - Street 1:2900 E 136TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3542
Practice Address - Country:US
Practice Address - Phone:303-996-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant