Organization
GENERATIONSPAN HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FLORENCE PEDATIN BAMGBOSE PHD ARNP (CEO)
(850) 264-9070
Entity
Organization
Contact information
Practice address
400 CAPITAL CIR SE STE 18128, TALLAHASSEE, FL 32301-3802
(850) 264-9070
Mailing address
6271 WILLIAMS RD, TALLAHASSEE, FL 32311-8526
(850) 264-9070
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
3314182
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305043200
—
FL
Enumeration date
11/21/2013
Last updated
11/21/2013
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