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General NPI Number Information
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NPI Number | 1649806027
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Entity Type | Organization
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Legal Business Name | EMERALD COAST SLEEP DIAGNOSTICS
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 620 MCKENZIE AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-3062
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Country | US
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Telephone | 850-518-7378
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Fax |
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Provider Business Mailing Address
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Address Line | 620 MCKENZIE AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-3062
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Country | US
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Telephone | 850-518-7378
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | AMBER MCKENZIE
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Credential | APRN
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Telephone | 850-518-7378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number |
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License Number State |
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