Provider Demographics
NPI:1639567944
Name:GARZA, JOSHUA (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:GARZA
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 1:3011 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4372
Mailing Address - Country:US
Mailing Address - Phone:308-630-2215
Mailing Address - Fax:308-632-7921
Practice Address - Street 1:3011 AVENUE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4372
Practice Address - Country:US
Practice Address - Phone:308-630-2215
Practice Address - Fax:308-632-7921
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant