Provider Demographics
NPI:1831819945
Name:TANASE, JULIE (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:TANASE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 E WILLIAMS FIELD RD STE 111
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0736
Mailing Address - Country:US
Mailing Address - Phone:480-795-1515
Mailing Address - Fax:480-597-1723
Practice Address - Street 1:2162 E WILLIAMS FIELD RD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0736
Practice Address - Country:US
Practice Address - Phone:480-795-1515
Practice Address - Fax:480-597-1723
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF08220244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ281103OtherSTATE LICENSE
AZ135256Medicaid