Healthcare Provider Details

I. General information

NPI: 1891420121
Provider Name (Legal Business Name): ERIC LAMARR ELMORE II PMHNP, AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W LAKEVIEW AVE
PENSACOLA FL
32501-1836
US

IV. Provider business mailing address

1221 W LAKEVIEW AVE
PENSACOLA FL
32501-1836
US

V. Phone/Fax

Practice location:
  • Phone: 850-469-3500
  • Fax: 850-595-1400
Mailing address:
  • Phone: 850-469-3500
  • Fax: 850-595-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11020945
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11020944
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9408112
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberGAA-NP000947
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: