Provider Demographics
NPI:1851347454
Name:TOBIAS, JOYCE ELAINE (APRN)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:ELAINE
Last Name:TOBIAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:ELAIN
Other - Last Name:WIGGLESWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8486
Mailing Address - Country:US
Mailing Address - Phone:360-575-8275
Mailing Address - Fax:360-575-1948
Practice Address - Street 1:1044 11TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2506
Practice Address - Country:US
Practice Address - Phone:360-575-8275
Practice Address - Fax:360-575-1948
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9648486Medicaid
TX8EC872Medicare PIN
WA9648486Medicaid