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General NPI Number Information
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NPI Number | 1063389377
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Entity Type | Organization
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Legal Business Name | THE SOUTHERN PRACTITIONER GROUP
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 2244 BERRYDALE RD
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City | PENSACOLA
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State | FL
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Zip | 32534-9525
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Country | US
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Telephone | 850-434-0077
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Fax | 850-434-0220
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Provider Business Mailing Address
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Address Line | PO BOX 101
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City | GONZALEZ
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State | FL
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Zip | 32560-0101
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Country | US
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Telephone | 850-434-0077
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Fax | 850-434-0220
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Authorized Official
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Title or Position | APRN/OWNER
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Name | JENNIFER M PRINCE
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Credential | APRN
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Telephone | 850-434-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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