Provider Demographics
NPI:1316248354
Name:JOHNSON, TAMARA M (FNP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 WALNUT KNOLL LN STE 201
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3112
Mailing Address - Country:US
Mailing Address - Phone:901-341-7200
Mailing Address - Fax:
Practice Address - Street 1:758 WALNUT KNOLL LN STE 201
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-3112
Practice Address - Country:US
Practice Address - Phone:901-341-7200
Practice Address - Fax:901-545-3200
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15282363LF0000X, 363LP0808X
AZ305486363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily