Healthcare Provider Details

I. General information

NPI: 1609497726
Provider Name (Legal Business Name): PRIMARY CARE OF THE GULF COAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 UNIVERSITY OFFICE BLVD STE 13A
PENSACOLA FL
32504-6247
US

IV. Provider business mailing address

600 UNIVERSITY OFFICE BLVD STE 13A
PENSACOLA FL
32504-6247
US

V. Phone/Fax

Practice location:
  • Phone: 850-254-4530
  • Fax: 850-366-9755
Mailing address:
  • Phone: 850-254-4530
  • Fax: 850-366-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JODILYN GRACE HOLZ
Title or Position: OWNER
Credential: NP
Phone: 850-254-4530