Provider Demographics
NPI:1215119219
Name:GROVE, JULIA DAWN HACKETT (CRNA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:DAWN HACKETT
Last Name:GROVE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:DAWN
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:7951 SHOAL CREEK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7582
Mailing Address - Country:US
Mailing Address - Phone:512-584-8404
Mailing Address - Fax:
Practice Address - Street 1:8015 SHOAL CREEK BLVD STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8051
Practice Address - Country:US
Practice Address - Phone:512-467-7246
Practice Address - Fax:512-467-7247
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117357367500000X
CA681712163W00000X
OK90842163W00000X
TX687284163W00000X
NHEL31275367500000X
OK0090842367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2000234-01Medicaid
TX2000234-01Medicaid
TX2000234-01Medicaid