Provider Demographics
NPI:1073406534
Name:JOHNSON, TAWANDA GILDERSLEEVE (RN)
Entity type:Individual
Prefix:
First Name:TAWANDA
Middle Name:GILDERSLEEVE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10558 EASTERN SHORE BLVD APT 821
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-5856
Mailing Address - Country:US
Mailing Address - Phone:251-377-5083
Mailing Address - Fax:
Practice Address - Street 1:10558 EASTERN SHORE BLVD APT 821
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-5856
Practice Address - Country:US
Practice Address - Phone:251-377-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-105217163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management