Organization
EMERALD WATERS MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MAURICIA STANTON ARNP (OWNER/PROVIDER)
(850) 582-6059
Entity
Organization
Contact information
Practice address
1005 COLLEGE BLVD W, SUITE B, NICEVILLE, FL 32578-1060
(850) 279-6815
(850) 279-6817
Mailing address
1005 COLLEGE BLVD W, SUITE B, NICEVILLE, FL 32578-1060
(850) 279-6815
(850) 279-6817
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
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
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