Provider Demographics
NPI:1588055990
Name:AVILA, JULIANA D (ARNP)
Entity type:Individual
Prefix:MISS
First Name:JULIANA
Middle Name:D
Last Name:AVILA
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 1:110 UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1139
Mailing Address - Country:US
Mailing Address - Phone:407-422-3790
Mailing Address - Fax:407-425-4358
Practice Address - Street 1:110 UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1139
Practice Address - Country:US
Practice Address - Phone:407-422-3790
Practice Address - Fax:407-425-4358
Is Sole Proprietor?:No
Enumeration Date:2015-02-08
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60565190363L00000X, 363LP2300X
FLAPRN9268772363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2044867Medicaid