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General NPI Number Information
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NPI Number | 1962002287
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Entity Type | Organization
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Legal Business Name | INTERVALCARE MEDICAL SERVICES
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 3601 PEBBLE LN
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City | MILTON
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State | FL
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Zip | 32583-2301
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Country | US
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Telephone | 850-356-0831
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1132
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City | PENSACOLA
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State | FL
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Zip | 32591-1132
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Country | US
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Telephone | 850-356-0831
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. ANYTA HICKS-WILLIAMS
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Credential | AGNP, PMHNP
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Telephone | 850-356-0831
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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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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health 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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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