Southern Practitioner

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9167682 Issued in FL

Legal business name

SOUTHERN PRACTITIONER

Practice address

15 W Maxwell St
Ste 148
Pensacola, FL 32501-1717

Phone

(850) 434-0077

Fax

(850) 434-0220

NPI assigned

Jan 13, 2018

Organization subpart

No

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

Authorized official

Name

Jennifer Prince, ARNPNPI 1699134916

Title

Owner

Phone

(850) 434-0077

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

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

• Jennifer Prince

  • Family Nurse Practitioner
  • Pensacola, FL
  • NPI 1699134916
  Medicare reassignment NPD Authorized official
• Ladonna Dapremont, ARNP

  • Gerontology Nurse Practitioner
  • Pensacola, FL
  • NPI 1497251003
  Medicare reassignment NPD
• Edward Scott Morrison, DO

  • Emergency Medicine Physician
  • Pensacola, FL
  • NPI 1679525430
  Medicare reassignment

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

{
    "created_epoch": "1515801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1326556200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 N 75TH AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325063820",
            "telephone_number": "850-434-0077",
            "fax_number": "850-434-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 W MAXWELL ST",
            "address_2": "STE 148",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325011717",
            "telephone_number": "850-434-0077",
            "fax_number": "850-434-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PRACTITIONER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-13",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A",
        "authorized_official_last_name": "PRINCE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-434-0077",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9167682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111684900",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Admin@southernpractitioner.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "15 W Maxwell St",
            "address_2": "Ste 148",
            "city": "Pensacola",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325011717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Southern Family Markets LLC
• Southern Home Care Services, Inc.
• Southern Oaks Facility Inc
• Southern Oaks Nursing and Rehab LLC
• Southern Orthopaedics and Sports Medicine
• Southern Spinal Rehab, LLC
• Matthew William Southwick, M.D.
• Lauren Soutullo, LMHC
• Peter K Soutullo, CRNA
• Luana Souza

• Family Nurse Practitioner in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.