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General NPI Number Information
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NPI Number | 1295368645
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Entity Type | Organization
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Legal Business Name | A TRUSTED NURSE PRACTITIONER
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 1101 GULF BREEZE PKWY STE 514
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City | GULF BREEZE
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State | FL
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Zip | 32561-4862
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Country | US
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Telephone | 850-990-9100
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Fax | 850-396-0142
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Provider Business Mailing Address
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Address Line | 6 OCEAN VIEW DR
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City | PENSACOLA BEACH
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State | FL
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Zip | 32561-2436
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Country | US
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Telephone | 850-384-6256
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RENEA KATHLEEN CLOWDSLEY
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Credential | APRN
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Telephone | 850-990-9100
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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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