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Organization
BANUELOS PSYCHIATRIC MENTAL HEALTHCARE LLC
Active
Organization
BANUELOS PSYCHIATRIC MENTAL HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER MICHELLE BANUELOS ARNP (NURSE PRACTITIONER)
(850) 983-8500
Entity
Organization
Contact information
Practice address
6061 DOCTORS PARK, MILTON, FL 32570-5073
(850) 983-8500
(850) 983-0009
Mailing address
6061 DOCTORS PARK, MILTON, FL 32570-5073
(850) 983-8500
(850) 983-0009
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020592000
—
FL
Enumeration date
02/14/2018
Last updated
02/14/2018
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