Healthcare Provider Details

I. General information

NPI: 1104932896
Provider Name (Legal Business Name): PAMELA D LOUDERBACK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 6TH STREET SOUTH
ST. PETERSBURG FL
33701-4814
US

IV. Provider business mailing address

5220 BELFORT RD SUITE 130
JACKSONVILLE FL
32256-6017
US

V. Phone/Fax

Practice location:
  • Phone: 904-446-3701
  • Fax: 888-507-9833
Mailing address:
  • Phone: 904-446-3701
  • Fax: 888-507-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberARNP1095812
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberARNP1095812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: