Healthcare Provider Details

I. General information

NPI: 1093420051
Provider Name (Legal Business Name): JOSHUA SETH CORPUZ MSN, AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HIGHLAND AVE STE 6
SALEM MA
01970-1783
US

IV. Provider business mailing address

400 HIGHLAND AVE STE 6
SALEM MA
01970-1783
US

V. Phone/Fax

Practice location:
  • Phone: 978-741-4133
  • Fax:
Mailing address:
  • Phone: 978-741-4133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN2348742
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2348742
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: