Individual
MISS PENNY ANN WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
10676 MARVIN JONES BLVD, LIVE OAK, FL 32064-8242
(386) 658-5582
Mailing address
14144 94TH TRL, LIVE OAK, FL 32060-6391
(386) 209-7728
(386) 658-2309
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
RN9357132
FL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
APRN11020708
FL
363L00000X
Nurse Practitioner
APRN11020708
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467199513
—
FL
01
—
APRN11020708
APRN LICENSE NUMBER
FL
Enumeration date
05/18/2022
Last updated
07/07/2024
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