Provider Demographics
NPI:1780848267
Name:PARK, JULIA THOMAS (NP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:THOMAS
Last Name:PARK
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:LORRAINE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5121 MARYLAND WAY STE 215
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7516
Mailing Address - Country:US
Mailing Address - Phone:615-557-7585
Mailing Address - Fax:615-246-3958
Practice Address - Street 1:5121 MARYLAND WAY STE 215
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7516
Practice Address - Country:US
Practice Address - Phone:615-557-7585
Practice Address - Fax:615-246-3958
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7739363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology