Healthcare Provider Details

I. General information

NPI: 1013657014
Provider Name (Legal Business Name): JOSHUA JORGENSEN MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 E 2100 S STE 101
SALT LAKE CITY UT
84105-3763
US

IV. Provider business mailing address

1327 E 2100 S STE 101
SALT LAKE CITY UT
84105-3763
US

V. Phone/Fax

Practice location:
  • Phone: 801-946-3399
  • Fax: 385-267-1191
Mailing address:
  • Phone: 801-946-3399
  • Fax: 385-267-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10875702-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: