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NPI Code Detail

MEDICARE: MS. PHYLLIS L PHELPS ARNP

MEDICARE: MS. PHYLLIS L PHELPS ARNP
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
1363LF0000XFamily Nurse PractitionerCNP 4348MN
2363LF0000XFamily Nurse Practitioner9232460FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770681595
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PHYLLIS L PHELPS ARNP
Provider Business Mailing Address
First Line : 2315 W JACKSON ST
Second Line :
City : PENSACOLA
State : FL
Zip : 32505-7552
Country : US
Telephone Number : 850-436-4630
Fax Number : 850-436-2095
Provider Business Practice Location Address
First Line : 2315 W JACKSON ST
Second Line :
City : PENSACOLA
State : FL
Zip : 32505-7552
Country : US
Telephone Number : 850-436-4630
Fax Number : 850-436-2095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 12/02/2025

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