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General NPI Number Information
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NPI Number | 1548742927
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Entity Type | Individual
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Provider Name | RAYMOND LEE HALSTEAD JR. ARNP
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Gender | Male
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Dates
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Enumeration Date | 09/03/2018
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Last Update Date | 09/03/2018
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Provider Practice Location Address
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Address Line | 5151 N 9TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32504-8795
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Country | US
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Telephone | 850-416-5046
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Fax |
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Provider Business Mailing Address
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Address Line | 3657 LAUREL LEE BLVD
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City | PACE
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State | FL
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Zip | 32571-6861
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Country | US
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Telephone | 512-585-8824
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9328166
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License Number State | FL
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