Healthcare Provider Details

I. General information

NPI: 1568512465
Provider Name (Legal Business Name): JULIE BAILEY JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE ANNE BAILEY PA-C

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 KEMPSVILLE RD STE 309
NORFOLK VA
23502-3800
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 757-347-2712
  • Fax: 757-502-8933
Mailing address:
  • Phone: 561-948-0291
  • Fax: 561-859-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002444
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: