Provider Demographics
NPI:1386089225
Name:JOHNSON, JOANNA TIAIRA (FNP-BC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:TIAIRA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:TIAIRA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4389 BEAUFORT
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532
Mailing Address - Country:US
Mailing Address - Phone:252-466-0108
Mailing Address - Fax:
Practice Address - Street 1:4389 BEAUFORT
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532
Practice Address - Country:US
Practice Address - Phone:252-466-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily