Provider Demographics
NPI:1992296214
Name:JOSE, JOEY JOSE CRISTOBAL (APRN)
Entity type:Individual
Prefix:MR
First Name:JOEY JOSE
Middle Name:CRISTOBAL
Last Name:JOSE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8925 COLONIAL CENTER DR STE 2000
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-7813
Mailing Address - Country:US
Mailing Address - Phone:239-333-0995
Mailing Address - Fax:
Practice Address - Street 1:200 NE MOTHER JOSEPH PL STE 320
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3205
Practice Address - Country:US
Practice Address - Phone:360-514-6300
Practice Address - Fax:360-514-6301
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9379248363L00000X
OR10013567363L00000X
WAAP61401342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty