Provider Demographics
NPI:1194708065
Name:PIEPER, PAMELA (MSN, PNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PIEPER
Suffix:
Gender:F
Credentials:MSN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100197
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0197
Mailing Address - Country:US
Mailing Address - Phone:904-244-3913
Mailing Address - Fax:904-244-3870
Practice Address - Street 1:101 S NEWELL DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611
Practice Address - Country:US
Practice Address - Phone:904-244-3913
Practice Address - Fax:904-244-3870
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1589572363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000909774BMedicaid
FL3006565-00Medicaid
GA000909774BMedicaid
FLE2581YMedicare PIN
FL500020741Medicare PIN