Provider Demographics
NPI:1578059606
Name:BUCCIARELLI, JULIE CORINNE (APRN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CORINNE
Last Name:BUCCIARELLI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:1425 S HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3491
Practice Address - Country:US
Practice Address - Phone:813-253-2635
Practice Address - Fax:813-254-7142
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9362762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110255200Medicaid