Healthcare Provider Details

I. General information

NPI: 1285316760
Provider Name (Legal Business Name): JOSHUA DEEN FROSSARD NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 N MESA ST STE A
EL PASO TX
79902-1124
US

IV. Provider business mailing address

4305 N MESA ST STE A
EL PASO TX
79902-1124
US

V. Phone/Fax

Practice location:
  • Phone: 915-532-2477
  • Fax: 915-532-2470
Mailing address:
  • Phone: 915-532-2477
  • Fax: 915-532-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1073018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: