Individual
JANE A PRATT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
219 CREWILLA DR NW, FORT WALTON BEACH, FL 32548-3947
(850) 581-7700
(850) 244-5342
Mailing address
219 CREWILLA DR NW, FORT WALTON BEACH, FL 32548-3947
(850) 581-7700
(850) 244-5342
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R9474
BCBS PROVIDER NUMBER
FL
Enumeration date
12/02/2005
Last updated
07/09/2007
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