Provider Demographics
NPI:1316699713
Name:SCRUGGS, BOBBI AMBER (CPNP-PC)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:AMBER
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:SCRUGGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:1205 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-2133
Mailing Address - Country:US
Mailing Address - Phone:850-832-4479
Mailing Address - Fax:
Practice Address - Street 1:621 W BALDWIN RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3364
Practice Address - Country:US
Practice Address - Phone:850-747-3661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017746363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics