Provider Demographics
NPI:1790006583
Name:GROVES, JULIA M
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:M
Last Name:GROVES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JULIA
Other - Middle Name:M
Other - Last Name:LEISSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6680 DUCK POND LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-6603
Mailing Address - Country:US
Mailing Address - Phone:941-893-8528
Mailing Address - Fax:
Practice Address - Street 1:1261 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2219
Practice Address - Country:US
Practice Address - Phone:941-366-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9306667367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered