Provider Demographics
NPI:1609175033
Name:EZEPUE, JULIET N (: DNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:N
Last Name:EZEPUE
Suffix:
Gender:F
Credentials:: DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4305
Mailing Address - Country:US
Mailing Address - Phone:352-519-2896
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4305
Practice Address - Country:US
Practice Address - Phone:352-519-2896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X
FLAPRN9329086363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No376K00000XNursing Service Related ProvidersNurse's Aide