Healthcare Provider Details

I. General information

NPI: 1891103149
Provider Name (Legal Business Name): ARIEL PERRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARIEL BROMLOW PA-C

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 6TH ST SUITE 504
PANAMA CITY FL
32401-3661
US

IV. Provider business mailing address

8700 FRONT BEACH RD UNIT 2307
PANAMA CITY BEACH FL
32407-4277
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-0329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: