Healthcare Provider Details

I. General information

NPI: 1275463879
Provider Name (Legal Business Name): EC ADVANCED PRACTICE NURSING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WALTER MARTIN RD NE STE 201
FORT WALTON BEACH FL
32548-4958
US

IV. Provider business mailing address

25 WALTER MARTIN RD NE STE 201
FORT WALTON BEACH FL
32548-4958
US

V. Phone/Fax

Practice location:
  • Phone: 850-809-8062
  • Fax:
Mailing address:
  • Phone: 850-809-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. AMANDA PUETT
Title or Position: OWNER
Credential: FNP-C
Phone: 850-240-7145