Healthcare Provider Details

I. General information

NPI: 1629986401
Provider Name (Legal Business Name): JULIE MISHOE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 NW 68TH LN
GAINESVILLE FL
32653-0890
US

IV. Provider business mailing address

3606 NW 68TH LN
GAINESVILLE FL
32653-0890
US

V. Phone/Fax

Practice location:
  • Phone: 352-256-7582
  • Fax:
Mailing address:
  • Phone: 352-256-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: