Provider Demographics
NPI:1184626715
Name:YOUNGBLOOD, JULIE (ARNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12007 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2607
Mailing Address - Country:US
Mailing Address - Phone:850-234-5151
Mailing Address - Fax:850-234-3303
Practice Address - Street 1:12007 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407
Practice Address - Country:US
Practice Address - Phone:850-234-5151
Practice Address - Fax:850-234-3303
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3320582207P00000X
GARN280038207P00000X, 363LF0000X
FL3320582363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY052GOtherBCBSF GRP# 98513
FL306500600Medicaid
FL306500600Medicaid