Healthcare Provider Details

I. General information

NPI: 1942899299
Provider Name (Legal Business Name): STORMIE RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S FERDON BLVD STE B
CRESTVIEW FL
32536-5252
US

IV. Provider business mailing address

PO BOX 259
SHALIMAR FL
32579-0259
US

V. Phone/Fax

Practice location:
  • Phone: 850-362-6824
  • Fax: 850-362-6826
Mailing address:
  • Phone: 850-362-6824
  • Fax: 850-362-6826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-66850
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: