Healthcare Provider Details

I. General information

NPI: 1538734181
Provider Name (Legal Business Name): JESSICA RIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 COBBLE CRK
PENSACOLA FL
32504-8638
US

IV. Provider business mailing address

4221 FRASIER LN
PACE FL
32571-6249
US

V. Phone/Fax

Practice location:
  • Phone: 850-473-4800
  • Fax:
Mailing address:
  • Phone: 850-304-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: