Individual
MS. JULIE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1860 TOWN CENTER DR STE 460, RESTON, VA 20190-5901
(571) 222-2200
(712) 222-2025
Mailing address
3040 WILLIAMS DR STE 100, FAIRFAX, VA 22031-4618
(571) 350-8400
(703) 437-6549
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024172648
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235320516
—
VA
01
—
456035ZAN3
MEDICARE PTAN
DC
Enumeration date
08/05/2007
Last updated
11/11/2025
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