MEDICARE: JULINA TILLUS DORVAL ARNP

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	261QP2300X	Primary Care Clinic/Center
2	363LF0000X	Family Nurse Practitioner	ARNP3078052	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	:	1386918217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULINA TILLUS DORVAL ARNP

Provider Business Mailing Address
First Line	:	5260 SW 131ST TER
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-5415
Country	:	US
Telephone Number	:	305-627-3828
Fax Number	:	305-756-9392

Provider Business Practice Location Address
First Line	:	9999 NE 2ND AVE STE 214
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2345
Country	:	US
Telephone Number	:	305-756-9392
Fax Number	:	305-756-9392

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

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	02/23/2012

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