Healthcare Provider Details

I. General information

NPI: 1215505144
Provider Name (Legal Business Name): EMILIE L FUGATE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N PALAFOX ST STE 104
PENSACOLA FL
32501-2678
US

IV. Provider business mailing address

2114 CREIGHTON RD
PENSACOLA FL
32504-7218
US

V. Phone/Fax

Practice location:
  • Phone: 850-542-7314
  • Fax: 850-390-4804
Mailing address:
  • Phone: 850-696-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11011627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: