Provider Demographics
NPI:1528582558
Name:PAJUELO, JULIETA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JULIETA
Middle Name:
Last Name:PAJUELO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JULIETA
Other - Middle Name:
Other - Last Name:WALDRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-6650
Mailing Address - Fax:
Practice Address - Street 1:255 BORMAN DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3486
Practice Address - Country:US
Practice Address - Phone:321-434-6650
Practice Address - Fax:321-434-5867
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2794642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJC311ZOtherMEDICARE
FL022145000Medicaid