Healthcare Provider Details

I. General information

NPI: 1023787819
Provider Name (Legal Business Name): JACKIE LYNN JULIAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 SCHOOL HOUSE RD
ZOLFO SPRINGS FL
33890-2759
US

IV. Provider business mailing address

115 K D REVELL RD
WAUCHULA FL
33873-2051
US

V. Phone/Fax

Practice location:
  • Phone: 863-735-1221
  • Fax:
Mailing address:
  • Phone: 863-773-4161
  • Fax: 863-773-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN9437118
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: