Healthcare Provider Details

I. General information

NPI: 1710841747
Provider Name (Legal Business Name): JUSTIN FOX
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 GREEN ST
CLAYMONT DE
19703-2052
US

IV. Provider business mailing address

3301 GREEN ST
CLAYMONT DE
19703-2052
US

V. Phone/Fax

Practice location:
  • Phone: 302-797-1462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0013573
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: