MEDICARE: PAMELA PIEPER MSN, PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	1589572	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194708065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA PIEPER MSN, PNP

Provider Business Mailing Address
First Line	:	PO BOX 100197
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32610-0197
Country	:	US
Telephone Number	:	904-244-3913
Fax Number	:	904-244-3870

Provider Business Practice Location Address
First Line	:	101 S NEWELL DRIVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32611
Country	:	US
Telephone Number	:	904-244-3913
Fax Number	:	904-244-3870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	11/06/2009

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