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Organization
SMC2
Active
Organization
SMC2
Active
Other names
Southern-Breeze Medical Care
Organization subpart
No
Provider details
NPI number
Authorized official
LISA LEANNE KING (CO-OWNER, AGENT)
(850) 527-6489
Entity
Organization
Contact information
Practice address
215 W 6TH ST, PANAMA CITY, FL 32401-2645
(508) 527-6489
(850) 769-6673
Mailing address
4832 LONG LAKE RIDGE DR, CHIPLEY, FL 32428-3670
(850) 527-6489
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/29/2022
Last updated
08/29/2022
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