Individual
EMMA IME ANDEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2944 PENN AVE STE L, MARIANNA, FL 32448-2741
(850) 526-5500
(850) 526-5536
Mailing address
PO BOX 844, MARIANNA, FL 32447-0844
(850) 557-9202
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW 11297
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008993500
—
FL
Enumeration date
08/09/2012
Last updated
02/20/2019
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