1144620972 NPI number — MRS. ROSELLE MARIE SWILLEY NP-C, AGACNP-BC ARNP

Table of content: MRS. ROSELLE MARIE SWILLEY NP-C, AGACNP-BC ARNP (NPI 1144620972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144620972 NPI number — MRS. ROSELLE MARIE SWILLEY NP-C, AGACNP-BC ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWILLEY
Provider First Name:
ROSELLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C, AGACNP-BC ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOMONIT
Provider Other First Name:
ROSELLE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144620972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2699
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32513-2699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-934-0932
Provider Business Mailing Address Fax Number:
850-934-0737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2569 GULF BREEZE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULF BREEZE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32563-3043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-934-0932
Provider Business Practice Location Address Fax Number:
850-934-0737
Provider Enumeration Date:
08/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  9173596 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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