Healthcare Provider Details

I. General information

NPI: 1427783810
Provider Name (Legal Business Name): JULIE PETERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE GORDIE

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 EPIPHANY WAY
TRINITY FL
34655-9409
US

IV. Provider business mailing address

13027 BATTEN LN
ODESSA FL
33556-4053
US

V. Phone/Fax

Practice location:
  • Phone: 727-389-4442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: