Provider Demographics
NPI:1245229053
Name:PALLENTINO, JULIA C (ARNP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:C
Last Name:PALLENTINO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 CARE DR
Mailing Address - Street 2:SUITE D 100
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-3501
Mailing Address - Country:US
Mailing Address - Phone:850-841-1166
Mailing Address - Fax:850-942-5466
Practice Address - Street 1:2457 CARE DR
Practice Address - Street 2:SUITE D 100
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-3501
Practice Address - Country:US
Practice Address - Phone:850-841-1166
Practice Address - Fax:850-942-5466
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 579352363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99039OtherGROUP MEDICARE #
FL99039OtherGROUP BCBS #
FLCK0297OtherGROUP RR MEDICARE #
FLCK0297OtherGROUP RR MEDICARE #
FLP69076Medicare UPIN