Individual provider Active NPI

Paul A.J. Juliano

  • Family Nurse Practitioner
  • Crestview, FL
National Provider Identifier
1659245769
Registry record updated May 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11042540 Issued in FL
Practice address
102 Stephens LN
Crestview, FL 32539-8600
Phone
(850) 358-8528
NPI assigned
Oct 1, 2025
Last updated
May 7, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 7, 2026

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 APRN11042540 FL Primary

Addresses

Primary practice location

102 Stephens LN
Crestview, FL 32539-8600

Mailing address

102 Stephens LN
Crestview, FL 32539-8600
Phone (850) 358-8528

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20260516000613 FL Practitioner - Nurse Practitioner 6002385275

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1005 Mar Walt Dr
Fort Walton Beach, FL 32547-6707

102 Stephens LN
Crestview, FL 32539-8600

3 Hatley Rd
Belfast, ME 04915-6878

PO Box
Suite 114
Dixmont, ME 04932

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN11042540FLMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1759276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778112000000",
    "number": "1659245769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 STEPHENS LN",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325398600",
            "telephone_number": "850-358-8528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 STEPHENS LN",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325398600",
            "telephone_number": "850-358-8528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JULIANO",
        "first_name": "PAUL",
        "middle_name": "A.J.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-10-01",
        "last_updated": "2026-05-07",
        "certification_date": "2026-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11042540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

Verify at the official NPI Registry.