Provider Demographics
NPI:1043034697
Name:JOHNSON, TASHA (MSN, CRNP FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN, CRNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7416 CHURCH HILL RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-2808
Mailing Address - Country:US
Mailing Address - Phone:419-758-2178
Mailing Address - Fax:
Practice Address - Street 1:7416 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-2808
Practice Address - Country:US
Practice Address - Phone:410-498-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR229253163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse