MEDICARE: MRS. JULIE BOM CONSELHO ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN9214016	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356899587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE BOM CONSELHO ARNP

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

Provider Business Practice Location Address
First Line	:	775 W GRANADA BLVD STE 102
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5109
Country	:	US
Telephone Number	:	386-425-4480
Fax Number	:	386-425-4481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2016
Last Update Date	:	08/26/2019

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