| NPI | 1073783023 |
|---|---|
| Former Name | TIFFANY MARIE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY f4010881) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2018-05-16 |