Provider Demographics
NPI:1467206730
Name:SOARES CAVALCANTE IIZUKA, JULIANA (NP)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:SOARES CAVALCANTE IIZUKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 CRESSLYN RDG
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2600
Mailing Address - Country:US
Mailing Address - Phone:470-494-4648
Mailing Address - Fax:
Practice Address - Street 1:3280 HOWELL MILL RD NW STE 304
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4109
Practice Address - Country:US
Practice Address - Phone:404-388-6219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN285285363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner