Provider Demographics
NPI:1154018661
Name:ANDERSON, JULIA MARIE (PA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13106 MAGPIE PL
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-3907
Mailing Address - Country:US
Mailing Address - Phone:941-224-9465
Mailing Address - Fax:
Practice Address - Street 1:13106 MAGPIE PL
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-3907
Practice Address - Country:US
Practice Address - Phone:941-224-9465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant