Provider Demographics
NPI:1871290734
Name:DE SAGUN, JOSHUA CORTES (FNP- BC)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:CORTES
Last Name:DE SAGUN
Suffix:
Gender:M
Credentials:FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 MANDEVILLE LN APT 1212
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-6154
Mailing Address - Country:US
Mailing Address - Phone:909-702-4719
Mailing Address - Fax:
Practice Address - Street 1:5590 GENERAL WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2465
Practice Address - Country:US
Practice Address - Phone:703-914-6718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily