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
—
—
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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