Healthcare Provider Details

I. General information

NPI: 1336030329
Provider Name (Legal Business Name): JULIA E MCCUBBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 WIND CHIME LN
ST AUGUSTINE FL
32095-0095
US

IV. Provider business mailing address

134 WIND CHIME LN
ST AUGUSTINE FL
32095-0095
US

V. Phone/Fax

Practice location:
  • Phone: 386-972-3700
  • Fax: 904-587-1433
Mailing address:
  • Phone: 386-972-3700
  • Fax: 904-587-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: