Healthcare Provider Details

I. General information

NPI: 1619684222
Provider Name (Legal Business Name): NOELIA MARIA GARCIA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 03/14/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 MAR WALT DR. SUITE C
FORT WALTON BEACH FL
32547
US

IV. Provider business mailing address

3808 MISTY WAY
DESTIN FL
32541-2116
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-6801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11022747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: