Healthcare Provider Details

I. General information

NPI: 1215828413
Provider Name (Legal Business Name): JOSHUA MCLEAN AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14550 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32258-2460
US

IV. Provider business mailing address

11100 DOMAIN DR APT 104
JACKSONVILLE FL
32256-4137
US

V. Phone/Fax

Practice location:
  • Phone: 904-271-6840
  • Fax:
Mailing address:
  • Phone: 904-553-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number11040871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: