Provider Demographics
NPI:1760017206
Name:JOHNSEN, EVELIA (NP)
Entity type:Individual
Prefix:
First Name:EVELIA
Middle Name:
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CHIMNEY RD
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5541
Mailing Address - Country:US
Mailing Address - Phone:912-295-5560
Mailing Address - Fax:912-259-5562
Practice Address - Street 1:119 CHIMNEY RD
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5541
Practice Address - Country:US
Practice Address - Phone:912-295-5560
Practice Address - Fax:912-295-5562
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA265163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily