Healthcare Provider Details

I. General information

NPI: 1326641630
Provider Name (Legal Business Name): JOSEPH LINN GILL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GEORGIA ST NE STE E4
ALBUQUERQUE NM
87110-1388
US

IV. Provider business mailing address

3901 GEORGIA ST NE STE E4
ALBUQUERQUE NM
87110-1388
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-5128
  • Fax: 505-916-5128
Mailing address:
  • Phone: 505-916-5128
  • Fax: 505-916-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number62549
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: