Healthcare Provider Details

I. General information

NPI: 1154791333
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF HUDSON PECONIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 BAYOU RIDGE DR
PACE FL
32571-8649
US

IV. Provider business mailing address

4421 BAYOU RIDGE DR
PACE FL
32571-8649
US

V. Phone/Fax

Practice location:
  • Phone: 850-776-4658
  • Fax:
Mailing address:
  • Phone: 850-776-4658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberARNP9280320
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberARNP9280320
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License NumberARNP9280320
License Number StateFL

VIII. Authorized Official

Name: TAWANDA WILLIAMS
Title or Position: HUMAN RESOURCES GENERALIST
Credential:
Phone: 914-467-7341