Provider Demographics
NPI:1629547641
Name:TICE, JULIA NICHOLE (APRN)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:NICHOLE
Last Name:TICE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 HAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-2184
Mailing Address - Country:US
Mailing Address - Phone:850-726-0166
Mailing Address - Fax:
Practice Address - Street 1:1338 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1846
Practice Address - Country:US
Practice Address - Phone:850-638-6240
Practice Address - Fax:850-415-5010
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9497943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily