Provider Demographics
NPI:1154162543
Name:VANDERGRIFT, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:VANDERGRIFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 BROWDER ST
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3140
Mailing Address - Country:US
Mailing Address - Phone:419-356-5727
Mailing Address - Fax:
Practice Address - Street 1:2908 BROWDER ST
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3140
Practice Address - Country:US
Practice Address - Phone:419-356-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-01
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86254066133V00000X
FL86254066133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered