Provider Demographics
NPI:1649274333
Name:WOLF, JOSHUA MATTHEW (CRNA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MATTHEW
Last Name:WOLF
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15570 CASTLEGATE CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-1809
Mailing Address - Country:US
Mailing Address - Phone:813-731-9119
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR UNIT MEDDAC
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-526-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60812176367500000X
FLARNP9189812367500000X, 367500000X
MDR143353367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304732600Medicaid
FLG8044OtherBCBS FLORIDA
FLG8044ZMedicare ID - Type Unspecified
FLE8044S.Medicare UPIN
FL304732600Medicaid