Provider Demographics
NPI:1720405541
Name:DRISCOLL, JULIE ANN (APN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:8914 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1410
Mailing Address - Country:US
Mailing Address - Phone:309-691-9110
Mailing Address - Fax:
Practice Address - Street 1:8914 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1410
Practice Address - Country:US
Practice Address - Phone:309-691-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209011018Medicaid
ILMD3157333OtherDEA