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General NPI Number Information
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NPI Number | 1649976770
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Entity Type | Organization
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Legal Business Name | TUPELO PRIMARY CARE
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 412 N HIGHWAY 71
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City | WEWAHITCHKA
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State | FL
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Zip | 32465-4061
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Country | US
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Telephone | 850-227-8561
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Fax |
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Provider Business Mailing Address
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Address Line | 412 N HIGHWAY 71
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City | WEWAHITCHKA
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State | FL
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Zip | 32465-4061
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Country | US
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Telephone | 850-227-8561
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY MILLER
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Credential | NP
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Telephone | 850-227-8561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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