Provider Demographics
NPI:1063126282
Name:JENNINGS, JOSHUA GARRETT (APRN-DNP-AG)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:GARRETT
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:APRN-DNP-AG
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:5403 COLUMBIA DR S UNIT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1926
Mailing Address - Country:US
Mailing Address - Phone:360-223-7714
Mailing Address - Fax:
Practice Address - Street 1:11120 NE 33RD PL STE 202
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1444
Practice Address - Country:US
Practice Address - Phone:206-823-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61394796363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology