Provider Demographics
NPI:1285647099
Name:SANDWITH, JULIA A (PA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:SANDWITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:A
Other - Last Name:BONNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:918 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6706
Mailing Address - Country:US
Mailing Address - Phone:850-863-2006
Mailing Address - Fax:850-862-6264
Practice Address - Street 1:918 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6706
Practice Address - Country:US
Practice Address - Phone:850-863-2006
Practice Address - Fax:850-862-6264
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103056363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P28020Medicare UPIN