Provider Demographics
NPI:1902445281
Name:FINK, JULIANNE (PA)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:FINK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7855 ALTO CARO DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4305
Mailing Address - Country:US
Mailing Address - Phone:972-983-6573
Mailing Address - Fax:
Practice Address - Street 1:7855 ALTO CARO DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4305
Practice Address - Country:US
Practice Address - Phone:972-983-6573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPA13765363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program