Healthcare Provider Details

I. General information

NPI: 1295829182
Provider Name (Legal Business Name): JULIE ANN COREY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

2021 KINGSLEY AVE SUITE 105
ORANGE PARK FL
32073-5174
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-5400
  • Fax: 904-276-5430
Mailing address:
  • Phone: 904-276-5400
  • Fax: 904-276-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9242050
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: