Provider Demographics
NPI:1689368839
Name:ANDERSON, JULIE NICKOY
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:NICKOY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 OAK TRACK CRSE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-9310
Mailing Address - Country:US
Mailing Address - Phone:352-216-7089
Mailing Address - Fax:
Practice Address - Street 1:302 OAK TRACK CRSE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-9310
Practice Address - Country:US
Practice Address - Phone:352-216-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator