Healthcare Provider Details

I. General information

NPI: 1679709372
Provider Name (Legal Business Name): NICOLE M JOSHI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 NEW YORK ST
MEMPHIS TN
38104-5536
US

IV. Provider business mailing address

PO BOX 41016
MEMPHIS TN
38174-1016
US

V. Phone/Fax

Practice location:
  • Phone: 901-728-5858
  • Fax: 901-507-0558
Mailing address:
  • Phone: 901-728-5858
  • Fax: 901-507-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number8468
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: