Healthcare Provider Details

I. General information

NPI: 1023207297
Provider Name (Legal Business Name): JULIET FAY CNS, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5207 TROUBLE CREEK RD
NEW PORT RICHEY FL
34652-4915
US

IV. Provider business mailing address

5601 WILLOUGHBY NEWTON DR #27
CENTREVILLE VA
20120-1900
US

V. Phone/Fax

Practice location:
  • Phone: 727-847-0125
  • Fax:
Mailing address:
  • Phone: 703-850-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0015000775
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024165453
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS 9324382
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP 9324382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: