Provider Demographics
NPI:1538523402
Name:PAUL, JULIA PETERS
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:PETERS
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:PETERS
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:10898 TARIN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4808
Mailing Address - Country:US
Mailing Address - Phone:904-608-7855
Mailing Address - Fax:904-244-8991
Practice Address - Street 1:10898 TARIN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4808
Practice Address - Country:US
Practice Address - Phone:904-608-7855
Practice Address - Fax:904-244-8991
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2522982363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology