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Organization
SOUTHERN PRACTITIONER
Active
Organization
SOUTHERN PRACTITIONER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PRINCE ARNP (OWNER)
(850) 434-0077
Entity
Organization
Contact information
Practice address
15 W MAXWELL ST, STE 148, PENSACOLA, FL 32501-1717
(850) 434-0077
(850) 434-0220
Mailing address
904 N 75TH AVE, PENSACOLA, FL 32506-3820
(850) 434-0077
(850) 434-0220
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9167682
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111684900
—
FL
Enumeration date
01/13/2018
Last updated
11/22/2022
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