Provider Demographics
NPI:1104427798
Name:VELASQUEZ, JULIANE (CLC)
Entity type:Individual
Prefix:
First Name:JULIANE
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 LACKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-4341
Mailing Address - Country:US
Mailing Address - Phone:585-775-5968
Mailing Address - Fax:
Practice Address - Street 1:3041 LACKLAND AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-4341
Practice Address - Country:US
Practice Address - Phone:585-775-5968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL323786174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN