Individual
MS. EBONY TASHA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
462 QUEEN ST FL 3, SOUTHINGTON, CT 06489-1801
(860) 696-2240
Mailing address
1290 SILAS DEANE HWY, WETHERSFIELD, CT 06109-4337
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
7774
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008082536
—
CT
01
—
7774
APRN LICENSE
CT
Enumeration date
08/22/2018
Last updated
01/28/2025
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