Provider Demographics
NPI:1437402021
Name:MORAME, JULIA ST JUSTE
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ST JUSTE
Last Name:MORAME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 WATKINS RD
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:FL
Mailing Address - Zip Code:33844
Mailing Address - Country:US
Mailing Address - Phone:863-269-9753
Mailing Address - Fax:863-353-8142
Practice Address - Street 1:5500 WATKINS RD
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:FL
Practice Address - Zip Code:33844
Practice Address - Country:US
Practice Address - Phone:863-269-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906270374U00000X
311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000422700Medicaid