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General NPI Number Information
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NPI Number | 1447524384
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Entity Type | Organization
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Legal Business Name | EMERALD COAST CARE SYSTEM, LLC
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 1157 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32561-4835
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Country | US
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Telephone | 850-462-7969
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Fax | 850-462-7946
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Provider Business Mailing Address
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Address Line | 1157 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32561-4835
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Country | US
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Telephone | 850-462-7969
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Fax | 850-462-7946
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Authorized Official
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Title or Position | CEO
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Name | DAVID R LAWSON
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Credential |
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Telephone | 850-462-7969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | ARNP9180138
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License Number State | FL
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