Individual
JOSHUA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5432 E SOUTHERN AVE STE 101B, MESA, AZ 85206-2772
(480) 999-7911
Mailing address
5432 E SOUTHERN AVE STE 101B, MESA, AZ 85206-2772
(480) 999-7911
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
246232
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
246232
APRN NUMBER
AZ
Enumeration date
08/11/2020
Last updated
08/11/2020
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