Basic Information
| Provider Information | |||||||||
| NPI: | 1376872424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JULIAN | ||||||||
| FirstName: | PRISCILLA | ||||||||
| MiddleName: | CHEREE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30046 SOTOGRANDE LOOP | ||||||||
| Address2: | |||||||||
| City: | WESLEY CHAPEL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335437043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139944724 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2403 E HENRY AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336104434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139887633 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2009 | ||||||||
| LastUpdateDate: | 12/21/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | RN2967122 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.