Provider Demographics
NPI:1477897692
Name:ANDERSON, JULIE TOTTERDALE (DNP)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:TOTTERDALE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:TOTTERDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3040 N WICKHAM RD STE 10
Mailing Address - Street 2:WICKHAM EXECUTIVE CENTER
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2369
Mailing Address - Country:US
Mailing Address - Phone:321-428-4840
Mailing Address - Fax:321-428-4841
Practice Address - Street 1:3040 N WICKHAM RD STE 10
Practice Address - Street 2:WICKHAM EXECUTIVE CENTER
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2369
Practice Address - Country:US
Practice Address - Phone:321-428-4840
Practice Address - Fax:321-428-4841
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9225132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily