Provider Demographics
NPI:1386359859
Name:FOSS, JOSHUA BLAKE (APRN CNP)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:BLAKE
Last Name:FOSS
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 1:1221 MILES AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1243
Mailing Address - Country:US
Mailing Address - Phone:330-962-5970
Mailing Address - Fax:
Practice Address - Street 1:4575 STEPHENS CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3629
Practice Address - Country:US
Practice Address - Phone:330-499-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0033332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine