Individual
TANYA NICHOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2435 W BELVEDERE AVE, BALTIMORE, MD 21215-5224
(410) 601-6840
Mailing address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 521-2200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R192010
MD
Other
Enumeration date
08/30/2021
Last updated
10/21/2024
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