1962792028 NPI number — MRS. JAMIESON TAYLOR PETERMAN ARNP

Table of content: MRS. JAMIESON TAYLOR PETERMAN ARNP (NPI 1962792028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962792028 NPI number — MRS. JAMIESON TAYLOR PETERMAN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERMAN
Provider First Name:
JAMIESON
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
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:
1962792028
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7456 NAVARRE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAVARRE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32566-8192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-626-5459
Provider Business Mailing Address Fax Number:
850-475-4781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1549 AIRPORT BLVD
Provider Second Line Business Practice Location Address:
SUITE 340
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32504-8633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-416-2340
Provider Business Practice Location Address Fax Number:
850-416-2338
Provider Enumeration Date:
04/11/2011

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: 363LF0000X , with the licence number:  ARNP 9233889 , 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)

  • Identifier: ARNP 9233889 . This is a "STATE LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 003581300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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