Healthcare Provider Details

I. General information

NPI: 1720627870
Provider Name (Legal Business Name): JULIANNA HOPE MONCEAUX FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12319 N MOPAC EXPY STE 200
AUSTIN TX
78758-2497
US

IV. Provider business mailing address

12319 N MOPAC EXPY STE 200
AUSTIN TX
78758-2497
US

V. Phone/Fax

Practice location:
  • Phone: 512-973-8276
  • Fax:
Mailing address:
  • Phone: 512-973-8276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP142659
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: