Healthcare Provider Details

I. General information

NPI: 1174588404
Provider Name (Legal Business Name): SANDRA H PALMER ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E 19TH ST
PANAMA CITY FL
32405-4707
US

IV. Provider business mailing address

204 E 19TH ST
PANAMA CITY FL
32405-4707
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-5409
  • Fax: 850-763-7129
Mailing address:
  • Phone: 850-763-5409
  • Fax: 850-763-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP 891762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: