Provider Demographics
NPI:1811287279
Name:GIBBONS, JULIE IANNAZZONE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:IANNAZZONE
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:CATHERINE
Other - Last Name:IANNAZZONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:212 E BROAD ST APT 3104
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3074
Mailing Address - Country:US
Mailing Address - Phone:908-577-2297
Mailing Address - Fax:
Practice Address - Street 1:200 UNIVERSITY RDG
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3635
Practice Address - Country:US
Practice Address - Phone:864-372-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1007952363LF0000X
SC21281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily