Healthcare Provider Details

I. General information

NPI: 1548533045
Provider Name (Legal Business Name): JULIE ROSE PAULY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22395 EDGEWATER DR
PORT CHARLOTTE FL
33980-2012
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD ATTN: CREDENTIAL DEPT
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 941-766-7222
  • Fax: 941-766-0970
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9263733
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9263733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: