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General NPI Number Information
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NPI Number | 1093626053
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Entity Type | Organization
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Legal Business Name | PERFORMANCE MD LLC
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 15700 PANAMA CITY BEACH PKWY UNIT 380
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City | PANAMA CITY
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State | FL
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Zip | 32413-5432
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Country | US
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Telephone | 850-238-4445
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Fax | 850-238-4440
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Provider Business Mailing Address
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Address Line | 1220 MAINE AVE
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City | LYNN HAVEN
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State | FL
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Zip | 32444-2126
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Country | US
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Telephone | 850-238-4445
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Fax | 850-238-4440
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Authorized Official
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Title or Position | CEO
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Name | TINA RENEE BUSH
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Credential |
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Telephone | 850-774-5659
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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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