Provider Demographics
NPI:1134363542
Name:COLLINS, JULIET SOSCIA (MD)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:SOSCIA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIET
Other - Middle Name:L
Other - Last Name:SOSCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4902 EISENHOWER BLVD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6344
Mailing Address - Country:US
Mailing Address - Phone:813-636-2000
Mailing Address - Fax:813-926-3041
Practice Address - Street 1:10909 W. LINEBAUGH AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1741
Practice Address - Country:US
Practice Address - Phone:813-792-8878
Practice Address - Fax:813-926-3041
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0010390-00Medicaid