Provider Demographics
NPI:1700179207
Name:THOMAS, JULIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 NIRA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8652
Mailing Address - Country:US
Mailing Address - Phone:904-387-4991
Mailing Address - Fax:904-384-3613
Practice Address - Street 1:1514 NIRA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8652
Practice Address - Country:US
Practice Address - Phone:904-384-4991
Practice Address - Fax:904-384-3613
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant