Provider Demographics
NPI:1841820099
Name:DOUGLAS, JUSTIN D (MSN, FNP, CNS, APRN)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:D
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MSN, FNP, CNS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 GEORGE DIETER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7653
Mailing Address - Country:US
Mailing Address - Phone:336-244-0444
Mailing Address - Fax:
Practice Address - Street 1:1400 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7653
Practice Address - Country:US
Practice Address - Phone:336-244-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM68193163W00000X, 363LF0000X, 364S00000X
CA95191512163W00000X
TX1180827364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine