Healthcare Provider Details

I. General information

NPI: 1639723737
Provider Name (Legal Business Name): JULIA LAINE GREENE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA LEONARD

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 03/07/2023
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLORIDA PAIN MEDICINE 325 CLYDE MORRIS BLVD SUITE 400
ORMOND BEACH FL
32174
US

IV. Provider business mailing address

FLORIDA PAIN MEDICINE 325 CLYDE MORRIS BLVD SUITE 400
ORMOND BEACH FL
32174
US

V. Phone/Fax

Practice location:
  • Phone: 386-671-0600
  • Fax:
Mailing address:
  • Phone: 386-671-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9331394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: