Provider Demographics
NPI:1659666733
Name:TINA JULES, PA
Entity type:Organization
Organization Name:TINA JULES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JULES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-857-7360
Mailing Address - Street 1:1628 SALERNO CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1904
Mailing Address - Country:US
Mailing Address - Phone:954-857-7360
Mailing Address - Fax:
Practice Address - Street 1:1825 FOREST HILL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6058
Practice Address - Country:US
Practice Address - Phone:954-857-7360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7797103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty