Healthcare Provider Details

I. General information

NPI: 1902897457
Provider Name (Legal Business Name): JOELLEN SUE FLORY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12234 PANAMA CITY BEACH PKWY SUITE C
PANAMA CITY BEACH FL
32407-2725
US

IV. Provider business mailing address

12234 PANAMA CITY BEACH PKWY SUITE C
PANAMA CITY BEACH FL
32407-2725
US

V. Phone/Fax

Practice location:
  • Phone: 850-233-2323
  • Fax: 850-233-1055
Mailing address:
  • Phone: 850-233-2323
  • Fax: 850-233-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9162754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: