Healthcare Provider Details

I. General information

NPI: 1689467177
Provider Name (Legal Business Name): AMBER NICOLE PASKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 06/30/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96TH MEDICAL GROUP 307 BOATNER ROAD, SUITE 114
EGLIN AFB FL
32542
US

IV. Provider business mailing address

96TH MEDICAL GROUP 307 BOATNER ROAD, SUITE 114
EGLIN AFB FL
32542
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: