Provider Demographics
NPI:1003847831
Name:BERTHY, JULIE ANN (ARNP)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:BERTHY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN BOWEN
Other - Last Name:BERTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-846-1532
Practice Address - Fax:352-392-0547
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1737822363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y0905ZMedicare PIN
P57022Medicare UPIN