Provider Demographics
NPI:1457051070
Name:ROSE, JULIA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4058 13TH ST # 1112
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6775
Mailing Address - Country:US
Mailing Address - Phone:407-361-5166
Mailing Address - Fax:
Practice Address - Street 1:2269 BUR OAK BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-6775
Practice Address - Country:US
Practice Address - Phone:407-361-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9429971163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant