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General NPI Number Information
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NPI Number | 1770902462
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE HOUSE CALLS PA
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 2744 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32563-3091
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Country | US
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Telephone | 850-934-5713
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Fax | 850-934-0379
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Provider Business Mailing Address
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Address Line | 2744 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32563-3091
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Country | US
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Telephone | 850-934-5713
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Fax | 850-934-0379
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Authorized Official
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Title or Position | PA, OWNER
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Name | MS. MARY ANN CRUMLISH
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Credential | PA
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Telephone | 850-516-8737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP1866262
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | ARNP9102271
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9102271
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License Number State | FL
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