Provider Demographics
NPI:1962072751
Name:JOHNSON, ELAINA SUE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ELAINA
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19323 LAGUNA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1826
Mailing Address - Country:US
Mailing Address - Phone:832-683-0358
Mailing Address - Fax:
Practice Address - Street 1:10750 BARKER CYPRESS RD STE 103
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2282
Practice Address - Country:US
Practice Address - Phone:832-509-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine