Provider Demographics
NPI:1982781977
Name:JOHNSON, TARMA JEAN (FNP-BC)
Entity type:Individual
Prefix:
First Name:TARMA
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TARMA
Other - Middle Name:JEAN
Other - Last Name:ADERINKOMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1575 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2122
Mailing Address - Country:US
Mailing Address - Phone:617-898-9042
Mailing Address - Fax:617-296-8701
Practice Address - Street 1:1575 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2122
Practice Address - Country:US
Practice Address - Phone:617-898-9057
Practice Address - Fax:617-296-5408
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA186837363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P64973Medicare UPIN