MEDICARE: JOELLEN SUE FLORY 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
1	363LF0000X	Family Nurse Practitioner	ARNP 9162754	FL

General Provider Information

NPI Number	:	1902897457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOELLEN SUE FLORY ARNP

Provider Business Mailing Address
First Line	:	12234 PANAMA CITY BEACH PKWY
Second Line	:	SUITE C
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2725
Country	:	US
Telephone Number	:	850-233-2323
Fax Number	:	850-233-1055

Provider Business Practice Location Address
First Line	:	12234 PANAMA CITY BEACH PKWY
Second Line	:	SUITE C
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2725
Country	:	US
Telephone Number	:	850-233-2323
Fax Number	:	850-233-1055

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	03/09/2011

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