# GENERATIONSPAN HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275963662
- **Authorized official:** MS. FLORENCE PEDATIN BAMGBOSE PHD ARNP (CEO)
- **Authorized official phone:** (850) 264-9070

## Contact information

- **Practice address:** 400 CAPITAL CIR SE STE 18128, TALLAHASSEE, FL 32301-3802
- **Practice address phone:** (850) 264-9070
- **Mailing address:** 6271 WILLIAMS RD, TALLAHASSEE, FL 32311-8526
- **Mailing address phone:** (850) 264-9070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LG0600X | Gerontology Nurse Practitioner | 3314182 | FL | Yes |

## Other

- **Enumeration date:** 11/21/2013
- **Last updated:** 11/21/2013