Healthcare Provider Details

I. General information

NPI: 1912941394
Provider Name (Legal Business Name): BLUEWATER ORTHOPEDICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 BLUEWATER BLVD SUITE 100
NICEVILLE FL
32578-3887
US

IV. Provider business mailing address

1950 BLUEWATER BLVD SUITE 100
NICEVILLE FL
32578-3887
US

V. Phone/Fax

Practice location:
  • Phone: 850-897-8081
  • Fax: 850-897-1520
Mailing address:
  • Phone: 850-897-8081
  • Fax: 850-897-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0070428
License Number StateFL

VIII. Authorized Official

Name: MRS. LINDA ANN STRICKLAND
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 850-897-8081