# EMERALD WATERS MEDICAL CLINIC LLC

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

## Provider details

- **NPI number:** 1306192216
- **Authorized official:** MS. MAURICIA STANTON ARNP (OWNER/PROVIDER)
- **Authorized official phone:** (850) 582-6059

## Contact information

- **Practice address:** 1005 COLLEGE BLVD W, SUITE B, NICEVILLE, FL 32578-1060
- **Practice address phone:** (850) 279-6815
- **Practice address fax:** (850) 279-6817
- **Mailing address:** 1005 COLLEGE BLVD W, SUITE B, NICEVILLE, FL 32578-1060
- **Mailing address phone:** (850) 279-6815
- **Mailing address fax:** (850) 279-6817

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | ARNP3114742 | FL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |
| 363LW0102X | Women's Health Nurse Practitioner | ARNP3114742 | FL | — |

## Other

- **Enumeration date:** 07/28/2012
- **Last updated:** 08/03/2022