Provider Demographics
NPI:1225505316
Name:HEREDIA, JULIO (LPN)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:HEREDIA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 DAPHNE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-4074
Mailing Address - Country:US
Mailing Address - Phone:407-456-6798
Mailing Address - Fax:
Practice Address - Street 1:7613 DAPHNE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-4074
Practice Address - Country:US
Practice Address - Phone:407-456-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5156363164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse