Provider Demographics
NPI:1952953416
Name:OQUENDO, JULIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:OQUENDO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 PATTERSON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6261
Mailing Address - Country:US
Mailing Address - Phone:863-353-6363
Mailing Address - Fax:
Practice Address - Street 1:280 PATTERSON RD STE 3
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-6261
Practice Address - Country:US
Practice Address - Phone:863-353-6363
Practice Address - Fax:949-655-5932
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000782363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104338300Medicaid