Provider Demographics
NPI:1396753042
Name:CANADA, JULIE B (ARNP-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:B
Last Name:CANADA
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:B
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:831 SIMPSON ROAD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744
Mailing Address - Country:US
Mailing Address - Phone:407-200-2300
Mailing Address - Fax:407-200-1365
Practice Address - Street 1:603 NORTH WASHINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796
Practice Address - Country:US
Practice Address - Phone:321-268-5008
Practice Address - Fax:321-607-6690
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3052252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307211800Medicaid
FL307211800Medicaid