Healthcare Provider Details

I. General information

NPI: 1164017612
Provider Name (Legal Business Name): EMILY TOWERY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 COLLEGE BLVD W STE H
NICEVILLE FL
32578-1049
US

IV. Provider business mailing address

20 HIGDON CT NW
FORT WALTON BEACH FL
32547-1610
US

V. Phone/Fax

Practice location:
  • Phone: 850-279-4417
  • Fax:
Mailing address:
  • Phone: 850-496-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11039304
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11039304
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-155862
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9691572
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-155862
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: