Provider Demographics
NPI:1043898448
Name:JAVA, JOSIELYN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JOSIELYN
Middle Name:
Last Name:JAVA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:M JOSIELYN
Other - Middle Name:AYOP
Other - Last Name:JAVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:35240 HOGAN DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7407
Mailing Address - Country:US
Mailing Address - Phone:951-846-7261
Mailing Address - Fax:
Practice Address - Street 1:35240 HOGAN DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-7407
Practice Address - Country:US
Practice Address - Phone:951-846-7261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF02210661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily