Healthcare Provider Details

I. General information

NPI: 1053787101
Provider Name (Legal Business Name): TALITHA BRIESE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 STEWART ST
MILTON FL
32570-4304
US

IV. Provider business mailing address

1221 W LAKEVIEW AVE
PENSACOLA FL
32501-1836
US

V. Phone/Fax

Practice location:
  • Phone: 850-983-5500
  • Fax: 850-983-5530
Mailing address:
  • Phone: 850-469-3500
  • Fax: 850-595-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9271143
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: