Provider Demographics
NPI:1053807602
Name:JOHNSON, SHERONDA LATRECIA (ACNP-C)
Entity type:Individual
Prefix:
First Name:SHERONDA
Middle Name:LATRECIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ACNP-C
Other - Prefix:
Other - First Name:SHERONDA
Other - Middle Name:LATRECIA
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 PARNASSUS AVE RM MUW -405
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2203
Mailing Address - Country:US
Mailing Address - Phone:415-353-8890
Mailing Address - Fax:
Practice Address - Street 1:500 PARNASSUS AVE RM MUW -405
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2203
Practice Address - Country:US
Practice Address - Phone:415-353-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010260363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053807602OtherNONE