Provider Demographics
NPI:1497481576
Name:BLANKS, JULIA WINTERS (NP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:WINTERS
Last Name:BLANKS
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 1:1102 10TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-1226
Mailing Address - Country:US
Mailing Address - Phone:256-294-5565
Mailing Address - Fax:
Practice Address - Street 1:1102 10TH AVE NE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-1226
Practice Address - Country:US
Practice Address - Phone:256-294-5565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-125962363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health