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General NPI Number Information
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NPI Number | 1629547641
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Entity Type | Individual
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Provider Name | JULIA NICHOLE TICE APRN
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Gender | Female
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 1338 SOUTH BLVD
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City | CHIPLEY
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State | FL
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Zip | 32428-1846
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Country | US
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Telephone | 850-638-6240
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Fax | 850-415-5010
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Provider Business Mailing Address
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Address Line | 991 HAYWOOD DR
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City | CHIPLEY
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State | FL
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Zip | 32428-2184
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Country | US
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Telephone | 850-726-0166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9497943
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License Number State | FL
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