Basic Information
| Provider Information | |||||||||
| NPI: | 1386208536 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PANNELL | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 W JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325057552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504364630 | ||||||||
| FaxNumber: | 8504362095 | ||||||||
| Practice Location | |||||||||
| Address1: | 5855 CREEK STATION DR | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504354352 | ||||||||
| FaxNumber: | 8504976195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2019 | ||||||||
| LastUpdateDate: | 06/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | APRN11006579 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.