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General NPI Number Information
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NPI Number | 1770727232
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Entity Type | Organization
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Legal Business Name | PETRIE GERIATRIC HEALTHCARE INC
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 1286 FERNANDO CIR
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City | CANTONMENT
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State | FL
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Zip | 32533-5737
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Country | US
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Telephone | 850-516-1919
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 37277
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City | PENSACOLA
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State | FL
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Zip | 32526
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Country | US
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Telephone | 850-623-2948
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CLAIRE A PETRIE
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Credential | ARNP
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Telephone | 850-516-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | ARNP1222292
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License Number State | FL
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