Provider Demographics
NPI:1376189209
Name:TOMCHAK, JULIE INDEPENDENCE (CNA/LNA/PCT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:INDEPENDENCE
Last Name:TOMCHAK
Suffix:
Gender:F
Credentials:CNA/LNA/PCT
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:INDEPENDENCE
Other - Last Name:TOMCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BAXTER
Mailing Address - Street 1:7805 US HIGHWAY LOT 29 # 98 N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809
Mailing Address - Country:US
Mailing Address - Phone:603-491-2415
Mailing Address - Fax:
Practice Address - Street 1:7805 US HIGHWAY LOT 29 # 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809
Practice Address - Country:US
Practice Address - Phone:603-491-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACNA34744376K00000X
FL384331376K00000X
ID000000009281MT376K00000X
NH046617-24376K00000X
MT340591376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide