Provider Demographics
NPI:1053462085
Name:SMITH, JULIE RENEE (ARNP-C, DNP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP-C, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1917
Mailing Address - Country:US
Mailing Address - Phone:850-526-5300
Mailing Address - Fax:850-482-5021
Practice Address - Street 1:4318 5TH AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2182
Practice Address - Country:US
Practice Address - Phone:850-526-5300
Practice Address - Fax:850-482-5021
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3287492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y04LAOtherBLUE CROSS BLUE SHIELD
FL307971600Medicaid
FL307971600Medicaid