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General NPI Number Information
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NPI Number | 1558716811
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Entity Type | Organization
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Legal Business Name | PHYSICIAN ASSOCIATES OF THE PALM BEACHES
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Dates
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Enumeration Date | 04/24/2016
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Last Update Date | 04/24/2016
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Provider Practice Location Address
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Address Line | 49 SKYSTONE CT
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City | PENSACOLA
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State | FL
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Zip | 32506-6842
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Country | US
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Telephone | 561-633-9913
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Fax | 561-403-1103
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Provider Business Mailing Address
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Address Line | 49 SKYSTONE CT
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City | PENSACOLA
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State | FL
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Zip | 32506-6842
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Country | US
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Telephone | 561-633-9913
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Fax | 561-403-1103
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LINDA FORD
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Credential | PA-C
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Telephone | 561-633-9913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9101814
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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