Healthcare Provider Details

I. General information

NPI: 1659245769
Provider Name (Legal Business Name): PAUL A.J. JULIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 STEPHENS LN
CRESTVIEW FL
32539-8600
US

IV. Provider business mailing address

102 STEPHENS LN
CRESTVIEW FL
32539-8600
US

V. Phone/Fax

Practice location:
  • Phone: 850-358-8528
  • Fax:
Mailing address:
  • Phone: 850-358-8528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11042540
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: