Provider Demographics
NPI:1831248186
Name:SHORT, JOAN S (FNP-C)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:S
Last Name:SHORT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:JOAN
Other - Middle Name:C
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 71061
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28272-1061
Mailing Address - Country:US
Mailing Address - Phone:704-786-6521
Mailing Address - Fax:704-782-9703
Practice Address - Street 1:270 COPPERFIELD BLVD NE
Practice Address - Street 2:SUITE 102
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2441
Practice Address - Country:US
Practice Address - Phone:704-786-6521
Practice Address - Fax:704-782-9703
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-02512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003882Medicaid
NC7003882Medicaid