Provider Demographics
NPI:1114299245
Name:LIES, JOSHUA STEPHEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:STEPHEN
Last Name:LIES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 MARSHCREEK LN
Mailing Address - Street 2:UNIT 102
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-7949
Mailing Address - Country:US
Mailing Address - Phone:239-596-1930
Mailing Address - Fax:
Practice Address - Street 1:2610 MARSHCREEK LN
Practice Address - Street 2:UNIT 102
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-7949
Practice Address - Country:US
Practice Address - Phone:239-596-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106373363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical