Healthcare Provider Details

I. General information

NPI: 1992947550
Provider Name (Legal Business Name): JULIE M WELLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2009
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PALM AVE STE 600
JACKSONVILLE FL
32207-8457
US

IV. Provider business mailing address

PO BOX 746654
ATLANTA GA
30374-6654
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-7300
  • Fax: 904-202-2754
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11038674
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA.10625-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRS648303
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: