Organization Active NPI

SMC2

  • Family Nurse Practitioner
  • Panama City, FL
National Provider Identifier
1235859646
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
SMC2
Practice address
215 W 6TH St
Panama City, FL 32401-2645
Phone
(508) 527-6489
Fax
(850) 769-6673
NPI assigned
Aug 29, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa Leanne King
Title
Co-Owner, Agent
Phone
(850) 527-6489

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

215 W 6TH St
Panama City, FL 32401-2645

Mailing address

4832 Long Lake Ridge Dr
Chipley, FL 32428-3670
Phone (850) 527-6489

Other names 1

  • Southern-Breeze Medical Care Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661731200000",
    "number": "1235859646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4832 LONG LAKE RIDGE DR",
            "city": "CHIPLEY",
            "state": "FL",
            "postal_code": "324283670",
            "telephone_number": "850-527-6489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W 6TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012645",
            "telephone_number": "508-527-6489",
            "fax_number": "850-769-6673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMC2",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-29",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "LEANNE",
        "authorized_official_title_or_position": "CO-OWNER, AGENT",
        "authorized_official_telephone_number": "850-527-6489"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern-Breeze Medical Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.