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General NPI Number Information
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NPI Number | 1750823233
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Entity Type | Organization
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Legal Business Name | PROHEALTH
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 1100 AIRPORT BLVD. B
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City | PENSACOLA
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State | FL
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Zip | 32504
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Country | US
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Telephone | 850-549-3379
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Fax |
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Provider Business Mailing Address
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Address Line | 3298 SUMMIT BLVD. SUITE 33
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City | PENSACOLA
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State | OH
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Zip | 32503
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Country | US
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Telephone | 850-434-6168
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Fax | 850-434-3145
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Authorized Official
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Title or Position | OPERATIONS OFFICER
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Name | DEBBIE DUFOUR
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Credential |
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Telephone | 850-434-6168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ARNP9365811
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License Number State | FL
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