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General NPI Number Information
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NPI Number | 1629686027
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Entity Type | Individual
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Provider Name | SANDRA DENISE PERCY-SMITH
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Gender | Female
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 105 JAZZ DR
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City | PANAMA CITY
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State | FL
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Zip | 32405-4906
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Country | US
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Telephone | 850-745-5111
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Fax | 850-745-5222
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Provider Business Mailing Address
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Address Line | 778 CASON CIR
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City | PANAMA CITY
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State | FL
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Zip | 32405-6471
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Country | US
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Telephone | 754-368-0069
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Fax | 850-745-5222
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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 | APRN11012976
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9454129
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License Number State | FL
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