Provider Demographics
NPI:1508335217
Name:BORCHARDT, JULIE ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:BORCHARDT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5619
Mailing Address - Country:US
Mailing Address - Phone:940-264-2625
Mailing Address - Fax:940-264-6401
Practice Address - Street 1:1601 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5619
Practice Address - Country:US
Practice Address - Phone:940-264-2625
Practice Address - Fax:940-264-6401
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139097363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner