Provider Demographics
NPI:1588436810
Name:JOHNSON, TIMOTHY II
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:JOHNSON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LANDMARK SQ STE 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6872
Mailing Address - Country:US
Mailing Address - Phone:757-477-3165
Mailing Address - Fax:
Practice Address - Street 1:116 LANDMARK SQ STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6872
Practice Address - Country:US
Practice Address - Phone:757-477-3165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA5534373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist