Healthcare Provider Details

I. General information

NPI: 1245018944
Provider Name (Legal Business Name): JULIANNE TOMAC DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 REGENCY PARK STE 100
O FALLON IL
62269-1887
US

IV. Provider business mailing address

PO BOX 25228
DECATUR IL
62525-5228
US

V. Phone/Fax

Practice location:
  • Phone: 618-416-7970
  • Fax: 618-416-7971
Mailing address:
  • Phone: 217-329-3232
  • Fax: 217-329-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023037611
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: