Provider Demographics
NPI:1194885350
Name:PRN OF NW FLORIDA INC
Entity type:Organization
Organization Name:PRN OF NW FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-916-0788
Mailing Address - Street 1:P.O. BOX 244
Mailing Address - Street 2:
Mailing Address - City:GONZELEZ
Mailing Address - State:FL
Mailing Address - Zip Code:32560
Mailing Address - Country:US
Mailing Address - Phone:850-723-6271
Mailing Address - Fax:
Practice Address - Street 1:2 SUGAR BOWL LANE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32561
Practice Address - Country:US
Practice Address - Phone:850-723-6271
Practice Address - Fax:850-916-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2210632251J00000X
FLARNP2210632363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302818600Medicaid
FL302818600Medicaid