Provider Demographics
NPI:1588400154
Name:KOSTILNIK, JULIE MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:KOSTILNIK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 GODWIN BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8038
Mailing Address - Country:US
Mailing Address - Phone:757-934-4821
Mailing Address - Fax:757-934-4276
Practice Address - Street 1:2800 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8038
Practice Address - Country:US
Practice Address - Phone:757-934-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190546363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner