Provider Demographics
NPI:1780222166
Name:JULIE STAATS DO FAMILY MEDICINE
Entity Type:Organization
Organization Name:JULIE STAATS DO FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAATS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-279-3040
Mailing Address - Street 1:2600 PARTIN DR N STE 120
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1543
Mailing Address - Country:US
Mailing Address - Phone:850-279-3040
Mailing Address - Fax:
Practice Address - Street 1:2600 PARTIN DR N STE 120
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1543
Practice Address - Country:US
Practice Address - Phone:850-279-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty