Provider Demographics
NPI:1053492967
Name:HILLSTROM, JULIE ANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:HILLSTROM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 PICKFAIR TER
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5800
Mailing Address - Country:US
Mailing Address - Phone:407-810-4040
Mailing Address - Fax:
Practice Address - Street 1:291 SOUTHHALL LN
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7274
Practice Address - Country:US
Practice Address - Phone:407-667-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2969652367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209005386OtherILLINOIS STATE LICENSE
FL2969652OtherFLORIDA STATE LICENSE
K14741Medicare ID - Type Unspecified