Provider Demographics
NPI:1366105744
Name:JOST, JULIANNE MARIE (AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:MARIE
Last Name:JOST
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 RIVARD BLVD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1256
Mailing Address - Country:US
Mailing Address - Phone:810-956-3877
Mailing Address - Fax:
Practice Address - Street 1:839 RIVARD BLVD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1256
Practice Address - Country:US
Practice Address - Phone:810-956-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704343090363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care