Healthcare Provider Details

I. General information

NPI: 1831248186
Provider Name (Legal Business Name): JOAN S. SHORT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JOAN C SAWYER

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 COPPERFIELD BLVD NE SUITE 102
CONCORD NC
28025-2441
US

IV. Provider business mailing address

PO BOX 71061
CHARLOTTE NC
28272-1061
US

V. Phone/Fax

Practice location:
  • Phone: 704-786-6521
  • Fax: 704-782-9703
Mailing address:
  • Phone: 704-786-6521
  • Fax: 704-782-9703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0050-02512
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: