Provider Demographics
NPI:1528144458
Name:JOHNSON, TAMMI (PA)
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TAMMI
Other - Middle Name:
Other - Last Name:JOHNSON-BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20050 HARVARD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6800
Mailing Address - Country:US
Mailing Address - Phone:216-751-1212
Mailing Address - Fax:216-991-4587
Practice Address - Street 1:20050 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-751-1212
Practice Address - Fax:216-991-4587
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0110808Medicaid