Provider Demographics
NPI:1861146698
Name:DEVORE, JULIE ANNA
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNA
Last Name:DEVORE
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:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-0627
Mailing Address - Country:US
Mailing Address - Phone:904-616-0952
Mailing Address - Fax:
Practice Address - Street 1:944 CHAPEAU RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5820
Practice Address - Country:US
Practice Address - Phone:904-616-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management