MEDICARE: PRIMARY CARE HOUSE CALLS PA

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	363LF0000X	Family Nurse Practitioner	ARNP1866262	FL
2	363LG0600X	Gerontology Nurse Practitioner	ARNP9102271	FL
3	363AM0700X	Medical Physician Assistant	PA9102271	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1770902462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE HOUSE CALLS PA

Provider Business Mailing Address
First Line	:	2744 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-3091
Country	:	US
Telephone Number	:	850-934-5713
Fax Number	:	850-934-0379

Provider Business Practice Location Address
First Line	:	2744 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-3091
Country	:	US
Telephone Number	:	850-934-5713
Fax Number	:	850-934-0379

Authorized Official
Title or Position	:	PA, OWNER
Name	:	MS. MARY ANN CRUMLISH
Credential	:	PA
Telephone Number	:	850-516-8737

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	04/27/2023

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Directions to “PRIMARY CARE HOUSE CALLS PA ” Practice Location

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