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General NPI Number Information
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NPI Number | 1508679630
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Entity Type | Individual
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Provider Name | JENNIFER LEE PRUITT APRN
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Gender | Female
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 2004 LEWIS TURNER BLVD STE B
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1362
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Country | US
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Telephone | 850-226-7893
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Fax |
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Provider Business Mailing Address
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Address Line | 1940 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4542
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Country | US
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Telephone | 850-763-0017
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Fax | 850-692-5862
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11037419
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License Number State | FL
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