Healthcare Provider Details

I. General information

NPI: 1043230535
Provider Name (Legal Business Name): WILLIAM MARK GARNEY ARNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 BRICKYARD RD SUITE 5
CHIPLEY FL
32428-6303
US

IV. Provider business mailing address

1376 BRICKYARD RD SUITE 5
CHIPLEY FL
32428-6303
US

V. Phone/Fax

Practice location:
  • Phone: 850-638-4383
  • Fax: 850-638-4195
Mailing address:
  • Phone: 850-638-4383
  • Fax: 850-638-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP1650222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: