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General NPI Number Information
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NPI Number | 1992654719
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Entity Type | Organization
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Legal Business Name | PRIMARY WELLCARE LLC
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Dates
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Enumeration Date | 01/26/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 109 BONAIRE DR
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-6006
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Country | US
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Telephone | 850-919-4505
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Fax |
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Provider Business Mailing Address
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Address Line | 109 BONAIRE DR
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-6006
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Country | US
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Telephone | 850-919-4505
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARIANNE PINION FORD
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Credential | NP
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Telephone | 864-704-6863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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