MEDICARE: JACKIE LYNN JULIAN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	RN9437118	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023787819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE LYNN JULIAN RN

Provider Business Mailing Address
First Line	:	115 K D REVELL RD
Second Line	:
City	:	WAUCHULA
State	:	FL
Zip	:	33873-2051
Country	:	US
Telephone Number	:	863-773-4161
Fax Number	:	863-773-5056

Provider Business Practice Location Address
First Line	:	3215 SCHOOL HOUSE RD
Second Line	:
City	:	ZOLFO SPRINGS
State	:	FL
Zip	:	33890-2759
Country	:	US
Telephone Number	:	863-735-1221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	09/07/2021

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