Provider Demographics
NPI:1669024246
Name:BLACK, JOSHUA JAY (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAY
Last Name:BLACK
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13154 NAVARRE RD SW
Mailing Address - Street 2:
Mailing Address - City:BEACH CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44608-9749
Mailing Address - Country:US
Mailing Address - Phone:330-417-9497
Mailing Address - Fax:
Practice Address - Street 1:807 E WASHINGTON ST STE 220
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3330
Practice Address - Country:US
Practice Address - Phone:330-536-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025127363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health