Provider Demographics
NPI:1205178571
Name:INGLEBY, JOSHUA SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SCOTT
Last Name:INGLEBY
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 1:3636 EXECUTIVE CENTER DR STE G70
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1628
Mailing Address - Country:US
Mailing Address - Phone:512-687-1950
Mailing Address - Fax:
Practice Address - Street 1:3636 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1643
Practice Address - Country:US
Practice Address - Phone:512-371-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8568133-1206363A00000X
TX12967363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8568133-1206OtherLICENSE