Provider Demographics
NPI:1114817814
Name:WAKSER, JOSIE (PA-C)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:WAKSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 E TIERRA BUENA LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1640
Mailing Address - Country:US
Mailing Address - Phone:602-541-7719
Mailing Address - Fax:
Practice Address - Street 1:4200 E CAMELBACK RD STE 106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2718
Practice Address - Country:US
Practice Address - Phone:602-255-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant