MEDICARE: SANDRA H PALMER ARNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	ARNP 891762	FL

General Provider Information

NPI Number	:	1174588404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA H PALMER ARNP-C

Provider Business Mailing Address
First Line	:	204 E 19TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4707
Country	:	US
Telephone Number	:	850-763-5409
Fax Number	:	850-763-7129

Provider Business Practice Location Address
First Line	:	204 E 19TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4707
Country	:	US
Telephone Number	:	850-763-5409
Fax Number	:	850-763-7129

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	01/14/2013

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