Healthcare Provider Details

I. General information

NPI: 1275596983
Provider Name (Legal Business Name): ELIZABETH ANN HEDARIA MSN, FNP CCM CNLCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 N DAVIS HWY
PENSACOLA FL
32514-6093
US

IV. Provider business mailing address

8100 N DAVIS HWY
PENSACOLA FL
32514-6093
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-2466
  • Fax: 850-477-2525
Mailing address:
  • Phone: 850-477-2466
  • Fax: 850-477-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 3013852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: