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Provider Information for 1093976680

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1093976680

Calendar   Last Updated:  2021-03-18
  Certification Date:  2021-03-18


Name Value
NPI 1093976680
Enumeration Date 2008-06-17
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 5153 N 9TH AVE STE 404
PENSACOLA, FL 32504-5707
United States

Phone: 850-416-2554 | Fax: 850-416-7442
View Map External Link
Primary Practice Address 5153 N 9TH AVE
PENSACOLA, FL 32504-8785
United States

Phone: 850-416-2554 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 2084N0400X - Psychiatry & Neurology Neurology FL OS12822