Individual
MRS. TANISHA A JOHNSON-JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7095 CLYO RD, CENTERVILLE, OH 45459-4816
(937) 458-5084
(937) 458-5089
Mailing address
1755 FALLBROOK LN, CINCINNATI, OH 45240-1011
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN.CNP.026724
OH
363LA2200X
Adult Health Nurse Practitioner
APRN.CNP.026724
OH
363LG0600X
Gerontology Nurse Practitioner
APRN.CNP.062724
OH
Other
Enumeration date
11/08/2021
Last updated
11/16/2021
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