MEDICARE: NAVARRE PRIMARY CARE LLC

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	363LF0000X	Family Nurse Practitioner

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

General Provider Information

NPI Number	:	1457043051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVARRE PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	7565 FRANKFORT ST
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-7713
Country	:	US
Telephone Number	:
Fax Number	:	850-684-3066

Provider Business Practice Location Address
First Line	:	7552 NAVARRE PKWY UNIT 41
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-7309
Country	:	US
Telephone Number	:	850-313-1323
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. SHERRIE MELISSA KOENIGSEDER
Credential	:	APRN
Telephone Number	:	850-313-1323

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	01/30/2026

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