Provider Demographics
NPI:1750440657
Name:IELLIMO, JULIE LYNN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:LYNN
Last Name:IELLIMO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:3109 MEDICAL WAY
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870
Mailing Address - Country:US
Mailing Address - Phone:863-386-0786
Mailing Address - Fax:
Practice Address - Street 1:3109 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870
Practice Address - Country:US
Practice Address - Phone:863-386-0786
Practice Address - Fax:863-386-1848
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103930363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant