Provider Demographics
NPI:1255600581
Name:JOHNSON, THERESA CARLA NEGRIDO (PMHNP)
Entity type:Individual
Prefix:
First Name:THERESA CARLA
Middle Name:NEGRIDO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:THERESA CARLA
Other - Middle Name:BELARMINO
Other - Last Name:NEGRIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:71 BLANCA DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3729
Mailing Address - Country:US
Mailing Address - Phone:818-445-5414
Mailing Address - Fax:
Practice Address - Street 1:480 TESCONI CIR STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4691
Practice Address - Country:US
Practice Address - Phone:707-206-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL685968163WN0800X
CA95004522363LF0000X, 363LP0808X
CA3636364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine