Healthcare Provider Details

I. General information

NPI: 1942469796
Provider Name (Legal Business Name): LEIF ERIK STERNUNG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 BEAL PKWY SW
FORT WALTON BEACH FL
32548-5331
US

IV. Provider business mailing address

PO BOX 879
FORT WALTON BEACH FL
32549-0879
US

V. Phone/Fax

Practice location:
  • Phone: 850-243-7035
  • Fax: 850-243-8529
Mailing address:
  • Phone: 850-243-7035
  • Fax: 850-243-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberARNP3333912
License Number StateFL

VIII. Authorized Official

Name: MRS. CHARINA E PEREZ
Title or Position: OFFICE MANAGER
Credential: NA
Phone: 850-243-7035