Healthcare Provider Details

I. General information

NPI: 1952587461
Provider Name (Legal Business Name): PAMELA JEANNE JANSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA JEANNE MILLER APRN

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 IKE STEELE RD
WEWAHITCHKA FL
32465-2428
US

IV. Provider business mailing address

500 IKE STEELE RD
WEWAHITCHKA FL
32465-2428
US

V. Phone/Fax

Practice location:
  • Phone: 850-639-1312
  • Fax: 850-639-1305
Mailing address:
  • Phone: 850-639-1312
  • Fax: 850-639-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN2851152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: