1922488006 NPI number — JULIE STOFF

Table of content: JULIE STOFF (NPI 1922488006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922488006 NPI number — JULIE STOFF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOFF
Provider First Name:
JULIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1922488006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13269
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32317-3269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-219-1520
Provider Business Mailing Address Fax Number:
850-219-1521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2887 CRAWFORDVILLE HWY
Provider Second Line Business Practice Location Address:
UNIT 3
Provider Business Practice Location Address City Name:
CRAWFORDVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32327-2173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-922-6855
Provider Business Practice Location Address Fax Number:
850-926-2402
Provider Enumeration Date:
06/04/2015

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: 225200000X , with the licence number:  PTA 115 , 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)

  • Identifier: PTA 115 . This is a "PTA LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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