Provider Demographics
NPI:1366459927
Name:HITCHNER, JULIE KAY (PA)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:KAY
Last Name:HITCHNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:K
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4331 SUNBEAM LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8118
Mailing Address - Country:US
Mailing Address - Phone:904-226-5542
Mailing Address - Fax:
Practice Address - Street 1:4331 SUNBEAM LAKE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-226-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2915363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016995800Medicaid
FLY03LVOtherFL BLUE