Healthcare Provider Details

I. General information

NPI: 1508422106
Provider Name (Legal Business Name): JAMIE MARIE FLINK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MAR WALT DR
FORT WALTON BEACH FL
32547-6708
US

IV. Provider business mailing address

196 GRANDVIEW AVE
VALPARAISO FL
32580-1541
US

V. Phone/Fax

Practice location:
  • Phone: 850-862-1111
  • Fax:
Mailing address:
  • Phone: 305-282-8246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number902664
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9385342
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN151294
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11002676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: