Provider Demographics
NPI:1285111260
Name:JOHNSON, SHIRLINE BEVERLY (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:SHIRLINE
Middle Name:BEVERLY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 APPLE TREE LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9393
Mailing Address - Country:US
Mailing Address - Phone:302-310-7477
Mailing Address - Fax:
Practice Address - Street 1:124 SLEEPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5838
Practice Address - Country:US
Practice Address - Phone:302-449-3030
Practice Address - Fax:302-449-3040
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001113363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner