Healthcare Provider Details

I. General information

NPI: 1053784850
Provider Name (Legal Business Name): RENEE PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 N 9TH AVE STE 302
PENSACOLA FL
32504-8785
US

IV. Provider business mailing address

PO BOX 2699 ATTN: SHMG/HPE
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2250
  • Fax: 850-416-2536
Mailing address:
  • Phone: 850-416-2250
  • Fax: 850-416-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9216204
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: