Provider Demographics
NPI:1922580752
Name:JOSUE, JESSICA NATACHA (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NATACHA
Last Name:JOSUE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 NW 60TH AVE APT 453
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2283
Mailing Address - Country:US
Mailing Address - Phone:786-356-1790
Mailing Address - Fax:
Practice Address - Street 1:2801 NW 60TH AVE APT 453
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-2283
Practice Address - Country:US
Practice Address - Phone:786-356-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9319643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily