Provider Demographics
NPI:1700311453
Name:PELTON, JULIA S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:S
Last Name:PELTON
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 1:19562 SE INSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-5156
Mailing Address - Country:US
Mailing Address - Phone:850-237-6500
Mailing Address - Fax:850-237-6567
Practice Address - Street 1:19562 SE INSTITUTION DR
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-5156
Practice Address - Country:US
Practice Address - Phone:850-237-6500
Practice Address - Fax:850-237-6567
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005734363AM0700X
FL0110005734363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05501OtherMEDICARE GROUP