Provider Demographics
NPI:1003557752
Name:PROVIDENCE, JULIET D
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:D
Last Name:PROVIDENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:PROVIDENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1317 EDGEWATER DR # 4354
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6350
Mailing Address - Country:US
Mailing Address - Phone:424-206-0650
Mailing Address - Fax:407-789-3637
Practice Address - Street 1:1317 EDGEWATER DR # 4354
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:321-335-4327
Practice Address - Fax:407-789-3637
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01139113OtherTHE CALIFORNIA BOARD OF REGISTERED NURSING