1356899587 NPI number — MRS. JULIE BOM CONSELHO ARNP

Table of content: MRS. JULIE BOM CONSELHO ARNP (NPI 1356899587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356899587 NPI number — MRS. JULIE BOM CONSELHO ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOM CONSELHO
Provider First Name:
JULIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356899587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 N CLYDE MORRIS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32114-2709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-425-0141
Provider Business Mailing Address Fax Number:
386-226-4577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
775 W GRANADA BLVD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-425-4480
Provider Business Practice Location Address Fax Number:
386-425-4481
Provider Enumeration Date:
09/16/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  APRN9214016 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)