Provider Demographics
NPI:1528697190
Name:DILTZ, JOSHUA MARK (PA-S)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:MARK
Last Name:DILTZ
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 CLEARVIEW ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-2706
Mailing Address - Country:US
Mailing Address - Phone:505-610-5925
Mailing Address - Fax:
Practice Address - Street 1:291 S DAISY ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2362
Practice Address - Country:US
Practice Address - Phone:423-616-8315
Practice Address - Fax:423-616-8316
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4653363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant