Healthcare Provider Details

I. General information

NPI: 1013866847
Provider Name (Legal Business Name): FORGET-ME-NOT DEMENTIA CLINIC AND OTHER NEUROLOGY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 JENKS AVE STE B
PANAMA CITY FL
32405-4304
US

IV. Provider business mailing address

2428 JENKS AVE STE B
PANAMA CITY FL
32405-4304
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-4171
  • Fax: 850-215-4191
Mailing address:
  • Phone: 850-215-4171
  • Fax: 850-215-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER REEVES
Title or Position: CEO/OWNER
Credential: APRN
Phone: 956-793-3562