Healthcare Provider Details

I. General information

NPI: 1104801141
Provider Name (Legal Business Name): PAMELA JILL SVENDSEN M.D., DABFP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7552 NAVARRE PKWY SUITE 21
NAVARRE FL
32566-7305
US

IV. Provider business mailing address

PO BOX 6479
NAVARRE FL
32566-2079
US

V. Phone/Fax

Practice location:
  • Phone: 850-936-8343
  • Fax: 850-936-5338
Mailing address:
  • Phone: 850-936-8343
  • Fax: 850-936-5338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: