Provider Demographics
NPI:1386918217
Name:DORVAL, JULINA TILLUS (ARNP)
Entity type:Individual
Prefix:
First Name:JULINA
Middle Name:TILLUS
Last Name:DORVAL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 SW 131ST TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5415
Mailing Address - Country:US
Mailing Address - Phone:305-627-3828
Mailing Address - Fax:305-756-9392
Practice Address - Street 1:9999 NE 2ND AVE STE 214
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2345
Practice Address - Country:US
Practice Address - Phone:305-756-9392
Practice Address - Fax:305-756-9392
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
FLARNP3078052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily