Provider Demographics
NPI:1609205533
Name:OJIBWAY, JOSEPH C (FNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:OJIBWAY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-5307
Mailing Address - Country:US
Mailing Address - Phone:615-292-9770
Mailing Address - Fax:615-385-1842
Practice Address - Street 1:2637 MURFREESBORO PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3505
Practice Address - Country:US
Practice Address - Phone:615-250-1475
Practice Address - Fax:615-964-6951
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1533407Medicaid
TN10350I7959Medicare PIN