Individual
MR. ALLEN POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1 SOMDG, 113 LIELMANIS AVE, HURLBURT AFB, FL 32544
(850) 881-2569
Mailing address
1468 WELLINGTON CIR, ROCKLEDGE, FL 32955-4321
(321) 350-2045
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
11001842
FL
363LF0000X
Family Nurse Practitioner
APRN11001842
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841817798
—
FL
Enumeration date
06/26/2020
Last updated
07/22/2024
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