Healthcare Provider Details

I. General information

NPI: 1346758133
Provider Name (Legal Business Name): PATRICIA ANN EMSLIE AP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86175 COURTNEY ISLES WAY
YULEE FL
32097-3516
US

IV. Provider business mailing address

86175 COURTNEY ISLES WAY
YULEE FL
32097-3516
US

V. Phone/Fax

Practice location:
  • Phone: 561-465-1400
  • Fax: 561-465-1751
Mailing address:
  • Phone: 561-465-1400
  • Fax: 561-465-1751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2787
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA84699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: