Provider Demographics
NPI:1851053359
Name:ELLINGTON, JOSIAH TAYLOR (APRN)
Entity type:Individual
Prefix:
First Name:JOSIAH
Middle Name:TAYLOR
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 E 32ND ST STE 508
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2708
Mailing Address - Country:US
Mailing Address - Phone:512-807-3140
Mailing Address - Fax:
Practice Address - Street 1:1015 E 32ND ST STE 508
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2708
Practice Address - Country:US
Practice Address - Phone:512-807-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056781363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner