Provider Demographics
NPI:1417189473
Name:JOHANSSON, ANDREW MARK (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARK
Last Name:JOHANSSON
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Gender:
Credentials:PA-C
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Mailing Address - Street 1:730 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4562
Mailing Address - Country:US
Mailing Address - Phone:757-873-1554
Mailing Address - Fax:
Practice Address - Street 1:730 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4562
Practice Address - Country:US
Practice Address - Phone:757-873-1554
Practice Address - Fax:757-873-3239
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2025-04-14
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Provider Licenses
StateLicense IDTaxonomies
VA0110003089363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant