Provider Demographics
NPI:1164316857
Name:JACKSON, JOSHUA GRANT (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:GRANT
Last Name:JACKSON
Suffix:
Gender:M
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9510 W SAHARA AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8812
Mailing Address - Country:US
Mailing Address - Phone:702-843-1353
Mailing Address - Fax:
Practice Address - Street 1:9510 W SAHARA AVE STE 225
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8812
Practice Address - Country:US
Practice Address - Phone:702-843-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV878949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily