Basic Information
| Provider Information | |||||||||
| NPI: | 1356439574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH SANTA ROSA WOMEN'S CENTER, PA | ||||||||
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| OtherOrganizationName: | NAVARRE CENTER FOR WOMENS HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1931 ORTEGA ST | ||||||||
| Address2: | 5992 BERRYHILL RD, SUITE 203 | ||||||||
| City: | NAVARRE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325664111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509361316 | ||||||||
| FaxNumber: | 8509365808 | ||||||||
| Practice Location | |||||||||
| Address1: | 1931 ORTEGA ST | ||||||||
| Address2: | 5992 BERRYHILL RD, SUITE 203 | ||||||||
| City: | NAVARRE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325664111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509361316 | ||||||||
| FaxNumber: | 8509365808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BARBER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 8509361316 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME77422 | FL | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 363LW0102X | ARNP9211633 | FL | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.