Provider Demographics
NPI:1871000323
Name:JARVIS, JULIANNA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:NICOLE
Last Name:JARVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIANNA
Other - Middle Name:NICOLE
Other - Last Name:JARVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 BRICK RD STE 306
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2146
Mailing Address - Country:US
Mailing Address - Phone:856-596-0111
Mailing Address - Fax:856-596-7194
Practice Address - Street 1:100 BRICK RD STE 306
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2146
Practice Address - Country:US
Practice Address - Phone:856-596-0111
Practice Address - Fax:856-596-7194
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00458000207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology