Provider Demographics
NPI:1417796483
Name:JOHNSON, TIARA (RN)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1177 PLOVER CIR
Practice Address - Street 2:
Practice Address - City:PONDER
Practice Address - State:TX
Practice Address - Zip Code:76259-5473
Practice Address - Country:US
Practice Address - Phone:972-567-1034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX945325163W00000X, 163WC0400X, 163WW0101X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory