Provider Demographics
NPI:1376858746
Name:JOHNSON, CHRISTINA SUSANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SUSANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2617
Mailing Address - Country:US
Mailing Address - Phone:480-677-8282
Mailing Address - Fax:844-470-2777
Practice Address - Street 1:11749 W LONE MOUNTAIN PKWY UNIT 105
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-6801
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:844-470-2777
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0103396-C-NP363LF0000X
WAAP61635778363LF0000X
UT13794235-4405363LF0000X
GARN176056363LF0000X
VT101.0137534363LF0000X
FLTPAN2704363LF0000X
OHAPRN.CNP.0038228363LF0000X
AZ317529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ171842Medicaid