Provider Demographics
NPI:1104708957
Name:JERUE, JULIE (MSN, RN, LMT, CHT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:JERUE
Suffix:
Gender:F
Credentials:MSN, RN, LMT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8613 OLD KINGS RD S STE 302
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4845
Mailing Address - Country:US
Mailing Address - Phone:863-701-4403
Mailing Address - Fax:
Practice Address - Street 1:8613 OLD KINGS RD S STE 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4845
Practice Address - Country:US
Practice Address - Phone:863-701-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist