Provider Demographics
NPI:1245669316
Name:BRANCO, JULIA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:BRANCO
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 1:1002 PERUQUE CROSSING CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2362
Mailing Address - Country:US
Mailing Address - Phone:636-294-5900
Mailing Address - Fax:636-294-5908
Practice Address - Street 1:1002 PERUQUE CROSSING CT
Practice Address - Street 2:SUITE 101
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2362
Practice Address - Country:US
Practice Address - Phone:636-294-5900
Practice Address - Fax:636-294-5908
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013015686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1245669316Medicaid
1245669316OtherNPI
MOMA1721OtherMEDICARE GROUP PTAN