Individual
MRS. TIALICKA BURGOS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP-BC
Contact information
Practice address
49 MDG, 280 DAVID L GOLDFEIN ST, HOLLOMAN AFB, NM 88330-8273
(575) 572-3069
Mailing address
49 MDG, 280 DAVID L GOLDFEIN ST, HOLLOMAN AFB, NM 88330-8273
(575) 572-3069
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
24176717
VA
Other
Enumeration date
04/11/2016
Last updated
07/10/2025
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