Healthcare Provider Details

I. General information

NPI: 1740731421
Provider Name (Legal Business Name): DOUGLAS J PAWLING ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 CORTEZ BLVD
WEEKI WACHEE FL
34613-6389
US

IV. Provider business mailing address

10065 CORTEZ BLVD
WEEKI WACHEE FL
34613-6389
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-4660
  • Fax: 352-596-4674
Mailing address:
  • Phone: 352-596-4660
  • Fax: 352-596-4674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 9344026
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: