Healthcare Provider Details

I. General information

NPI: 1558139899
Provider Name (Legal Business Name): JULIA MARIE STADDON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 NW 33RD ST STE 204
CORAL SPRINGS FL
33065-4081
US

IV. Provider business mailing address

6012 KESTREL POINT AVE
LITHIA FL
33547-5021
US

V. Phone/Fax

Practice location:
  • Phone: 954-780-8685
  • Fax:
Mailing address:
  • Phone: 813-833-3068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9118299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: