Provider Demographics
NPI:1144884313
Name:MESSINEO, JULIA MARY
Entity type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:MARY
Last Name:MESSINEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 CARLISLE ST APT 104
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1392
Mailing Address - Country:US
Mailing Address - Phone:585-216-7305
Mailing Address - Fax:
Practice Address - Street 1:3028 COMMUNICATIONS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8914
Practice Address - Country:US
Practice Address - Phone:972-473-7444
Practice Address - Fax:972-473-7445
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant