Provider Demographics
NPI:1962792028
Name:PETERMAN, JAMIESON TAYLOR (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JAMIESON
Middle Name:TAYLOR
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7456 NAVARRE PKWY
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8192
Mailing Address - Country:US
Mailing Address - Phone:850-626-5459
Mailing Address - Fax:850-475-4781
Practice Address - Street 1:1549 AIRPORT BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8633
Practice Address - Country:US
Practice Address - Phone:850-416-2340
Practice Address - Fax:850-416-2338
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9233889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 9233889OtherSTATE LICENSE