1477897692 NPI number — DR. JULIE TOTTERDALE ANDERSON DNP

Table of content: DR. JULIE TOTTERDALE ANDERSON DNP (NPI 1477897692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477897692 NPI number — DR. JULIE TOTTERDALE ANDERSON DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
JULIE
Provider Middle Name:
TOTTERDALE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOTTERDALE
Provider Other First Name:
JULIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477897692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3040 N WICKHAM RD STE 10
Provider Second Line Business Mailing Address:
WICKHAM EXECUTIVE CENTER
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32935-2369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-428-4840
Provider Business Mailing Address Fax Number:
321-428-4841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3040 N WICKHAM RD STE 10
Provider Second Line Business Practice Location Address:
WICKHAM EXECUTIVE CENTER
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32935-2369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-428-4840
Provider Business Practice Location Address Fax Number:
321-428-4841
Provider Enumeration Date:
11/15/2012

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: 363LF0000X , with the licence number:  ARNP 9225132 , 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)





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