Provider Demographics
NPI:1114405503
Name:HARRISON, JOSHUA (NP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13771 N FOUNTAIN HILLS BLVD # 114-103
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3762
Mailing Address - Country:US
Mailing Address - Phone:888-662-3376
Mailing Address - Fax:786-453-0383
Practice Address - Street 1:13771 N FOUNTAIN HILLS BLVD # 114-103
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3762
Practice Address - Country:US
Practice Address - Phone:888-662-3376
Practice Address - Fax:786-453-0383
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11596363L00000X, 363LA2200X, 363LG0600X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology