Provider Demographics
NPI:1194348292
Name:SANDIFER, JOSHUA THOMAS (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:THOMAS
Last Name:SANDIFER
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:THOMAS
Other - Last Name:AGUILAR SANDIFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3676 SAGEBROOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5483
Mailing Address - Country:US
Mailing Address - Phone:219-465-8224
Mailing Address - Fax:
Practice Address - Street 1:9030 CLINE AVE STE A
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2204
Practice Address - Country:US
Practice Address - Phone:219-750-9497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28195432A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health