Healthcare Provider Details

I. General information

NPI: 1477868842
Provider Name (Legal Business Name): JOE LOUIS TOSCANO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 BRYANT IRVIN RD STE 100
FORT WORTH TX
76132-4251
US

IV. Provider business mailing address

7000 BRYANT IRVIN RD STE 100
FORT WORTH TX
76132-4251
US

V. Phone/Fax

Practice location:
  • Phone: 817-882-6338
  • Fax:
Mailing address:
  • Phone: 817-882-6338
  • Fax: 817-759-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: