MEDICARE: JOSHUA HARRISON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP11596	AZ
2	363LA2200X	Adult Health Nurse Practitioner	AP11596	AZ
3	363LG0600X	Gerontology Nurse Practitioner	AP11596	AZ
4	207N00000X	Dermatology Physician	AP11596	AZ

General Provider Information

NPI Number	:	1114405503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA HARRISON NP

Provider Business Mailing Address
First Line	:	13771 N FOUNTAIN HILLS BLVD # 114-103
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-3762
Country	:	US
Telephone Number	:	888-662-3376
Fax Number	:	786-453-0383

Provider Business Practice Location Address
First Line	:	13771 N FOUNTAIN HILLS BLVD # 114-103
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-3762
Country	:	US
Telephone Number	:	888-662-3376
Fax Number	:	786-453-0383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	10/01/2020

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