Provider Demographics
NPI:1023388824
Name:EPPLEY, JUSTIN (DNP, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:EPPLEY
Suffix:
Gender:M
Credentials:DNP, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 STENTON AVE
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-8317
Mailing Address - Country:US
Mailing Address - Phone:215-836-2440
Mailing Address - Fax:215-836-2509
Practice Address - Street 1:8765 STENTON AVE
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-8317
Practice Address - Country:US
Practice Address - Phone:215-836-2440
Practice Address - Fax:215-836-2509
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2024-10-19
Deactivation Date:2024-09-28
Deactivation Code:
Reactivation Date:2024-10-17
Provider Licenses
StateLicense IDTaxonomies
PASP030843363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2024055849OtherAMERICAN NURSES CREDENTIALING CENTER
PASP030843OtherPENNSYLVANIA STATE BOARD OF NURSING