1598059610 NPI number — DR. JAIME NICHOLE PRINCIPE PHARMD

Table of content: DR. JAIME NICHOLE PRINCIPE PHARMD (NPI 1598059610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598059610 NPI number — DR. JAIME NICHOLE PRINCIPE PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRINCIPE
Provider First Name:
JAIME
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598059610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4727 HIGHWAY 90
Provider Second Line Business Mailing Address:
T-2279
Provider Business Mailing Address City Name:
PACE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32571-1403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-995-7821
Provider Business Mailing Address Fax Number:
850-995-7821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4727 HIGHWAY 90
Provider Second Line Business Practice Location Address:
T-2279
Provider Business Practice Location Address City Name:
PACE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32571-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-995-7821
Provider Business Practice Location Address Fax Number:
850-995-7821
Provider Enumeration Date:
06/06/2011

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: 183500000X , with the licence number:  PS41180 , 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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