Provider Demographics
NPI:1710063490
Name:CARGILL, JULIANA MARY (ANP GNP)
Entity Type:Individual
Prefix:MS
First Name:JULIANA
Middle Name:MARY
Last Name:CARGILL
Suffix:
Gender:F
Credentials:ANP GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 MARVIN GARDENS LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5520
Mailing Address - Country:US
Mailing Address - Phone:928-776-8523
Mailing Address - Fax:
Practice Address - Street 1:500 N HWY 89
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN108844163W00000X
AZAP1063363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner