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General NPI Number Information
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NPI Number | 1013866847
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Entity Type | Organization
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Legal Business Name | FORGET-ME-NOT DEMENTIA CLINIC AND OTHER NEUROLOGY SERVICES LLC
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Dates
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Enumeration Date | 01/26/2026
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Last Update Date | 02/07/2026
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Provider Practice Location Address
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Address Line | 2428 JENKS AVE STE B
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City | PANAMA CITY
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State | FL
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Zip | 32405-4304
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Country | US
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Telephone | 850-215-4171
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Fax | 850-215-4191
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Provider Business Mailing Address
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Address Line | 2428 JENKS AVE STE B
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City | PANAMA CITY
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State | FL
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Zip | 32405-4304
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Country | US
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Telephone | 850-215-4171
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Fax | 850-215-4191
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Authorized Official
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Title or Position | CEO/OWNER
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Name | JENNIFER REEVES
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Credential | APRN
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Telephone | 956-793-3562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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