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General NPI Number Information
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NPI Number | 1326529355
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Entity Type | Organization
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Legal Business Name | PRINCE PROPERTIES
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 128 EGLIN PKWY SE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5519
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Country | US
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Telephone | 850-374-1203
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Fax |
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Provider Business Mailing Address
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Address Line | 128 EGLIN PKWY SE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5519
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Country | US
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Telephone | 850-374-1203
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LESLEY J PRINCE
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Credential |
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Telephone | 601-832-1465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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