Provider Demographics
NPI:1487162699
Name:MAGARA, JOAB ZEPHANIAH (FNP, CRNP)
Entity type:Individual
Prefix:
First Name:JOAB
Middle Name:ZEPHANIAH
Last Name:MAGARA
Suffix:
Gender:M
Credentials:FNP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 TERRY REILEY WAY
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-1774
Mailing Address - Country:US
Mailing Address - Phone:570-624-4444
Mailing Address - Fax:570-624-4450
Practice Address - Street 1:529 TERRY REILEY WAY
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1774
Practice Address - Country:US
Practice Address - Phone:570-624-4444
Practice Address - Fax:570-624-4450
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily