Healthcare Provider Details

I. General information

NPI: 1811387590
Provider Name (Legal Business Name): JULIE ELWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 STATE ROAD 20
INTERLACHEN FL
32148-2737
US

IV. Provider business mailing address

1302 RIVER ST
PALATKA FL
32177-5042
US

V. Phone/Fax

Practice location:
  • Phone: 386-684-4914
  • Fax: 386-684-4701
Mailing address:
  • Phone: 386-328-0108
  • Fax: 386-325-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW12462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: