Healthcare Provider Details

I. General information

NPI: 1902731888
Provider Name (Legal Business Name): DARA LYNN HUMPHRIES DNP, ARPN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2078 US HIGHWAY 98 W # 105-269
SANTA ROSA BEACH FL
32459-5372
US

IV. Provider business mailing address

2078 US HIGHWAY 98 W # 105-269
SANTA ROSA BEACH FL
32459-5372
US

V. Phone/Fax

Practice location:
  • Phone: 770-828-5512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11048334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: