Provider Demographics
NPI:1861041568
Name:BENNETT, JULIA DENISE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:DENISE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 W HIGHWAY 290 STE 103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-8500
Mailing Address - Country:US
Mailing Address - Phone:512-676-5853
Mailing Address - Fax:
Practice Address - Street 1:13110 W HIGHWAY 290 STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-8500
Practice Address - Country:US
Practice Address - Phone:512-676-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily