Provider Demographics
NPI:1265807523
Name:CAIRNS-MIGONE, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:CAIRNS-MIGONE
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 1:3896 SW HALE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4041
Mailing Address - Country:US
Mailing Address - Phone:772-418-3298
Mailing Address - Fax:
Practice Address - Street 1:10050 SW INNOVATION WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2117
Practice Address - Country:US
Practice Address - Phone:772-879-8700
Practice Address - Fax:772-879-8710
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7611133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND7611OtherLICENSE NUMBER