MEDICARE: JULIANNE EASTMOND

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	311ZA0620X	Adult Care Home Facility	6906763	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
2	6906763	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1659745461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNE EASTMOND

Provider Business Mailing Address
First Line	:	4504 LEE BLVD
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-1627
Country	:	US
Telephone Number	:	239-798-8764
Fax Number	:

Provider Business Practice Location Address
First Line	:	4504 LEE BLVD
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-1627
Country	:	US
Telephone Number	:	239-798-8764
Fax Number	:

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

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/17/2015

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Directions to “ JULIANNE EASTMOND ” Practice Location

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