Provider Demographics
NPI:1285172486
Name:EMERALD COAST FAMILY PHYSICIANS LLC
Entity type:Organization
Organization Name:EMERALD COAST FAMILY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISBETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:VERNALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-476-9691
Mailing Address - Street 1:4785 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2497
Mailing Address - Country:US
Mailing Address - Phone:850-476-9691
Mailing Address - Fax:
Practice Address - Street 1:4785 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2497
Practice Address - Country:US
Practice Address - Phone:850-476-0777
Practice Address - Fax:850-476-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064337208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF72872Medicare UPIN