Healthcare Provider Details

I. General information

NPI: 1457036071
Provider Name (Legal Business Name): JOBY DENNY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 15245
APO AP
96271-5245
US

IV. Provider business mailing address

PSC 444 BOX 767
APO AP
96297-0008
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1331
  • Fax:
Mailing address:
  • Phone: 104-339-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9598815
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11027068
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11027068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: