Provider Demographics
NPI:1841256674
Name:FASHNER, JULIA LYN (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:LYN
Last Name:FASHNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 W PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2966
Mailing Address - Country:US
Mailing Address - Phone:863-453-3121
Mailing Address - Fax:863-452-2823
Practice Address - Street 1:1006 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2966
Practice Address - Country:US
Practice Address - Phone:863-453-3121
Practice Address - Fax:863-452-2823
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053210A207Q00000X
FLME114166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200306900AMedicaid
OH2622764Medicaid
FL006776100Medicaid
OH2622764Medicaid
IN738460PPPPMedicare PIN
FL006776100Medicaid