Provider Demographics
NPI:1235128869
Name:GARCIA, PAMELA PAIGE (ARNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:PAIGE
Last Name:GARCIA
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 1:537 MEADOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1576
Mailing Address - Country:US
Mailing Address - Phone:850-321-8705
Mailing Address - Fax:
Practice Address - Street 1:537 MEADOW RIDGE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1576
Practice Address - Country:US
Practice Address - Phone:850-321-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1851212207R00000X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1033644026OtherGRP NPI
FL1851212OtherLIC NUMBER
GA458504308AMedicaid
FL000522000Medicaid
FLP00625820OtherRR MEDICARE
FL814349778OtherTAX ID
FL814349778OtherTAX ID
FLS80454Medicare UPIN