Organization · NPI-2

360 Blue Family Medical LLC

Nurse Practitioner, Family · Panama City, FL

NPI number1487439394
StatusActive
Last updated in NPPESSep 16, 2023

Details

NPI
1487439394
Entity type
Organization (NPI-2)
Legal business name
360 Blue Family Medical LLC
Organization subpart
No
Enumeration date
Aug 29, 2023
Certification date
Sep 16, 2023
Last updated
Sep 16, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, Family––Yes

Practice location

949 Jenks Ave Ste 6
Panama City, FL 32401-2584

Phone 904-853-0809

Mailing address

949 Jenks Ave Ste 6
Panama City, FL 32401-2584

Phone 904-853-0809

Authorized official

Samantha Blue
Employee
8503197345

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