Provider Demographics
NPI:1477191062
Name:ATKINS, JUSTIN DOUGLAS (MSN, RN, AGACNP-BC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:DOUGLAS
Last Name:ATKINS
Suffix:
Gender:M
Credentials:MSN, RN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19431 VERBENA ST
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-3347
Mailing Address - Country:US
Mailing Address - Phone:615-545-7996
Mailing Address - Fax:
Practice Address - Street 1:12740 HESPERIA RD STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8306
Practice Address - Country:US
Practice Address - Phone:760-998-1999
Practice Address - Fax:760-881-3555
Is Sole Proprietor?:No
Enumeration Date:2019-12-14
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013524363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95013524OtherCALIFORNIA BRN NP LICENSE NUMBER