Provider Demographics
NPI:1093547937
Name:LARSON, JOSHUA A (APRN, CNP)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:LARSON
Suffix:
Gender:M
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SPINDER DR STE 4015
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-0016
Mailing Address - Country:US
Mailing Address - Phone:309-308-5100
Mailing Address - Fax:309-308-5102
Practice Address - Street 1:133 SPINDER DR STE 4015
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-0016
Practice Address - Country:US
Practice Address - Phone:309-308-5100
Practice Address - Fax:309-308-5102
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030314363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner