Healthcare Provider Details

I. General information

NPI: 1487817367
Provider Name (Legal Business Name): AMY CHRISTINE LIPPINCOTT I ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 E REDSTONE AVE STE A
CRESTVIEW FL
32539-5350
US

IV. Provider business mailing address

129 E REDSTONE AVE STE A
CRESTVIEW FL
32539-5350
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-7212
  • Fax: 850-682-6727
Mailing address:
  • Phone: 850-682-7212
  • Fax: 850-682-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP3316432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: