Healthcare Provider Details

I. General information

NPI: 1639698822
Provider Name (Legal Business Name): JULIE M CONRAD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 N DON WICKHAM DR
CLERMONT FL
34711-1923
US

IV. Provider business mailing address

2013 VINE ST
LEESBURG FL
34748-5550
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-5922
  • Fax: 352-315-7587
Mailing address:
  • Phone: 502-744-6476
  • Fax: 352-315-7587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9460866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: