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General NPI Number Information
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NPI Number | 1215103437
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Entity Type | Organization
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Legal Business Name | TALLAHASSEE NEUROLOGICAL CLINIC PA
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 1401 CENTERVILLE RD SUITE 300
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4647
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Country | US
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Telephone | 850-878-8121
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Fax | 850-942-6515
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Provider Business Mailing Address
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Address Line | 1401 CENTERVILLE RD SUITE 300
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4647
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Country | US
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Telephone | 850-878-8121
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Fax | 850-942-6515
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Authorized Official
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Title or Position | PA
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Name | ANNETTE WILSON
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Credential | PA C
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Telephone | 850-878-8121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9104317
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License Number State | FL
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