Healthcare Provider Details

I. General information

NPI: 1760004774
Provider Name (Legal Business Name): ADVANCED HEALTHCARE SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12407 HIGHWAY 49 STE 2
GULFPORT MS
39503-4091
US

IV. Provider business mailing address

12407 HIGHWAY 49 STE 2
GULFPORT MS
39503-4091
US

V. Phone/Fax

Practice location:
  • Phone: 228-596-5749
  • Fax: 228-269-0002
Mailing address:
  • Phone: 228-596-5749
  • Fax: 228-269-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RHONDA FOLES
Title or Position: OWNER
Credential: DNP
Phone: 228-596-5749