Provider Demographics
NPI:1871085571
Name:SACERDOTE, JULIE CHRISTINE (PA-C)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:CHRISTINE
Last Name:SACERDOTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 460
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6001
Practice Address - Country:US
Practice Address - Phone:813-879-4328
Practice Address - Fax:813-443-8152
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106683600Medicaid