Provider Demographics
NPI:1396100566
Name:WARNER, JOHANNA T C (AGNP-C, MSN)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:T C
Last Name:WARNER
Suffix:
Gender:F
Credentials:AGNP-C, MSN
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:THEODOSIA
Other - Last Name:CROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP-C, MSN
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992159-NP363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner