Provider Demographics
NPI:1043230535
Name:GARNEY, WILLIAM MARK (ARNP-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MARK
Last Name:GARNEY
Suffix:
Gender:M
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1376 BRICKYARD RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-6303
Mailing Address - Country:US
Mailing Address - Phone:850-638-4383
Mailing Address - Fax:850-638-4195
Practice Address - Street 1:1376 BRICKYARD RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-6303
Practice Address - Country:US
Practice Address - Phone:850-638-4383
Practice Address - Fax:850-638-4195
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1650222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301428200Medicaid
FL660167700Medicaid
FLE1425XMedicare ID - Type Unspecified
FL660167700Medicaid