Healthcare Provider Details

I. General information

NPI: 1952953416
Provider Name (Legal Business Name): JULIE OQUENDO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 10/01/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PATTERSON RD STE 3
HAINES CITY FL
33844-6261
US

IV. Provider business mailing address

280 PATTERSON RD STE 3
HAINES CITY FL
33844-6261
US

V. Phone/Fax

Practice location:
  • Phone: 863-353-6363
  • Fax: 949-655-5932
Mailing address:
  • Phone: 863-353-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11000782
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: