Healthcare Provider Details

I. General information

NPI: 1669514162
Provider Name (Legal Business Name): CONSTANCE C EADIE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

709 KRISTANNA DR
PANAMA CITY FL
32405-3274
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-2020
  • Fax:
Mailing address:
  • Phone: 850-271-4239
  • Fax: 850-747-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3252912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: