Individual provider Active NPI

Julia Holsomback, APRN

  • Family Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1083179816
Registry record updated Feb 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9424941 Issued in FL
Practice address
11481 Old Saint Augustine Rd
Jacksonville, FL 32258-1473
Phone
(904) 633-0210
NPI assigned
Feb 6, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 9424941 FL Primary

Addresses

Primary practice location

11481 Old Saint Augustine Rd
Jacksonville, FL 32258-1473

Mailing address

12623 Shady Creek Dr
Jacksonville, FL 32223-2030
Phone (678) 662-4622

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210903000486 GA Practitioner - Nurse Practitioner 2365781507 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9424941FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cowry Medical Group, LLC CurrentSince Jul 24, 2023 Accepting new patients

Locations

4450 Calibre Xing NW
Ste 1126
Acworth, GA 30101
Phone (470) 227-8130

1720 Mars Hill Rd NW
Ste 120380
Acworth, GA 30101

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549411200000",
    "number": "1083179816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12623 SHADY CREEK DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322232030",
            "telephone_number": "678-662-4622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11481 OLD SAINT AUGUSTINE RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322581473",
            "telephone_number": "904-633-0210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLSOMBACK",
        "first_name": "JULIA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-06",
        "last_updated": "2019-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9424941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.