Healthcare Provider Details

I. General information

NPI: 1467113563
Provider Name (Legal Business Name): NEIGHBORHOOD CAREER ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 JENKS AVE STE 17
PANAMA CITY FL
32401-2585
US

IV. Provider business mailing address

2310 S HIGHWAY 77 STE 110-137
LYNN HAVEN FL
32444-4616
US

V. Phone/Fax

Practice location:
  • Phone: 850-771-4723
  • Fax:
Mailing address:
  • Phone: 850-771-4723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: LAURONDA STAPLES
Title or Position: OWNER
Credential: LPN
Phone: 850-771-4723