Healthcare Provider Details

I. General information

NPI: 1598487050
Provider Name (Legal Business Name): PRIMARY CARE & FUNCTIONAL MEDICINE CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 AIRPORT RD STE D
PANAMA CITY FL
32405-4025
US

IV. Provider business mailing address

508 AIRPORT RD STE D
PANAMA CITY FL
32405-4025
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-5930
  • Fax: 850-353-7006
Mailing address:
  • Phone: 850-215-5830
  • Fax: 850-353-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: YESENIA RAMOS
Title or Position: NURSE PRACTITIONER
Credential: APRN
Phone: 850-215-5830