Healthcare Provider Details

I. General information

NPI: 1962206334
Provider Name (Legal Business Name): JOSHUA DAVID RUNKLE RN, APRN-CNP STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 NEIL AVE
COLUMBUS OH
43201-2320
US

IV. Provider business mailing address

1577 NEIL AVE
COLUMBUS OH
43201-2320
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-4041
  • Fax:
Mailing address:
  • Phone: 614-292-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042413
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number157975
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN.471242
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: