Provider Demographics
NPI:1285269621
Name:JOHNSON, TANGIE NICOLE (CNA, OWNER, OPERATOR)
Entity type:Individual
Prefix:
First Name:TANGIE
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNA, OWNER, OPERATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 BOBOLINK LN NE
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-6733
Mailing Address - Country:US
Mailing Address - Phone:205-545-0113
Mailing Address - Fax:
Practice Address - Street 1:1609 BOBOLINK LN NE
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:AL
Practice Address - Zip Code:35215-6733
Practice Address - Country:US
Practice Address - Phone:205-545-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care