Provider Demographics
NPI:1023207297
Name:FAY, JULIET (CNS, ARNP)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:FAY
Suffix:
Gender:F
Credentials:CNS, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 WILLOUGHBY NEWTON DR
Mailing Address - Street 2:#27
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1900
Mailing Address - Country:US
Mailing Address - Phone:703-850-5565
Mailing Address - Fax:
Practice Address - Street 1:5207 TROUBLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4915
Practice Address - Country:US
Practice Address - Phone:727-847-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000775364SP0809X
VA0024165453363LP0808X
FLCNS 9324382364SP0809X
FLARNP 9324382363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult