Provider Demographics
NPI:1578367058
Name:JOHNSON, TARRENA AMY
Entity type:Individual
Prefix:
First Name:TARRENA
Middle Name:AMY
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:TARRENA
Other - Middle Name:AMY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2404 POMEROY RD SE APT 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3524
Mailing Address - Country:US
Mailing Address - Phone:202-281-6724
Mailing Address - Fax:
Practice Address - Street 1:2404 POMEROY RD SE APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3524
Practice Address - Country:US
Practice Address - Phone:202-281-6724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant