Provider Demographics
NPI:1861484693
Name:DEBOLD, JULIA MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:MARIE
Last Name:DEBOLD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 ROSA L PARKS BLVD
Mailing Address - Street 2:UNIT 429
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2502
Mailing Address - Country:US
Mailing Address - Phone:615-499-8934
Mailing Address - Fax:
Practice Address - Street 1:508 DAVIDSON ST
Practice Address - Street 2:#204
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37213-1414
Practice Address - Country:US
Practice Address - Phone:615-730-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1119363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q04596Medicare UPIN
3662076Medicare ID - Type Unspecified