Healthcare Provider Details

I. General information

NPI: 1114842242
Provider Name (Legal Business Name): JOSHUA JAMES CORCORAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 N TATUM BLVD STE 185
PHOENIX AZ
85028-6016
US

IV. Provider business mailing address

PO BOX 39675
PHOENIX AZ
85069-9675
US

V. Phone/Fax

Practice location:
  • Phone: 602-669-2585
  • Fax: 602-669-2586
Mailing address:
  • Phone: 602-669-2585
  • Fax: 602-669-2586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN193238
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: