Provider Demographics
NPI:1013657014
Name:JORGENSEN, JOSHUA (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 E 2100 S STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3763
Mailing Address - Country:US
Mailing Address - Phone:801-946-3399
Mailing Address - Fax:385-267-1191
Practice Address - Street 1:1327 E 2100 S STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3763
Practice Address - Country:US
Practice Address - Phone:801-946-3399
Practice Address - Fax:385-267-1191
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10875702-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily